In two experimental studies we sought preliminary information about the behavior of concrements lost in the peritoneal cavity during laparoscopic cholecystectomy. Materials and Methods: In study 1, human gallstones were analyzed using X-ray diffraction, calssified in three groups and examined with an ultramicroscope; then they were implanted in the peritoneal cavity of rats. After 8 weeks or 6 months, the animals were sacrificed and the concrements analyzed again as before. The tissues surrouding the calculi were also examined histologically. In study 2, human gallstones were examined with regard to bacterial contamination on the surface or in the middle of the calculi. The cholesterol content was analyzed, and the stones were divided into three groups and implantated in the rats as in the first study. After 8 weeks, the animals were sacrificed and areas with identifiable tissue reactions were examined histologically and microbiologically. Results: The concrements lost their crystalline formation without any relation to their former cholesterol content, as shown by X-ray diffraction as well as ultramicroscopy. Mineralogically, these changes are a certain sign of structural dissolution. Cholesterol stones only caused abscess formations in association with gram-negative bowel germs. Sterile pigment concrements often led to a mesenchymal reaction such as granulomas. Contaminated pigment stones also resulted in extensive abscess formations.

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Experimental emphysema was induced by multiple intratracheal instillation of Papain in a dose of 2 mg/kg body weight in 4 bastard dogs. Development of emphysema was objectivated by pulmonary function tests. Increase of static lung compliance, decrease of lung elastance, and increase of air-way resistance were observed. In addition arterial pO2 decreased while pCO2 remained constant. Following single lung homotransplantation there was an increase of respiratory rate and minute ventilation, the transpulmonary pressure rose in the first postoperative days, static lung compliance was diminished. Four weeks after transplantation typical functional changes of emphysema could be demonstrated concerning the slope and appearance of the compliance loops. Arterial pO2 however remained within the normal range. This functional behaviour does not support the concept of a ventialtion perfusion imbalance after lung transplantation in emphysema patients. Respiratory insufficiency therefore is probably caused by an alveolar type of rejection.

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ZusammenfassungDie Hämodynamik nach Lungentransplantation wurde an 20 Tieren unter Zuhilfenahme der akuten und der chronischen elektromagnetischen Strömungsmeßtechnik mit und ohne immunsuppressiver Therapie untersucht.Es fand sich neben der typischen Abstoßungsreaktion, wie sie bei anderen Organen bekannt ist, eine "alveoläre" Manifestation der Abstoßung, die bei nahezu ungestörter Perfusion durch Ventilationseinschränkung zu Störung des Perfusions-Ventilations-Verhältnisses und zu respiratorischer Insuffizienz führt.Die atemphysiologische Beurteilung eines Lungenhomotransplantates 16 Monate postoperativ ergab eine Zweidrittelfunktion des Transplantates gegenüber der Eigenlunge. Results Following Canine Pulmonary TransplantationThe hemodynamic following pulmonary transplantation has been investigated in 20 dogs using acute and chronic electromagnetic flowmeter technique.Besides the typical rejection phenomena as in other organs an alveolar manifestation of rejection of the lung -accompanied by near normal perfusion, but decrease in ventilation -was noted, resulting in a perfusion ventilation inbalance and respiratory insufficiency.16 months postoperatively a two third function of the transplant compared to the own lung of a long-time surviver could be demonstrated.Bei über 30 bisher klinisch durchgeführten Lungentransplantationen waren die unbefriedigenden Ergebnisse auf eine unzureichende Funktion des Transplantates zurückzuführen. Als Hauptursache wurde in den meisten Fällen eine schwere Störung des Ventilations-Perfusions-Verhältnisses gefunden. Veith hat eine derartige Störung des Ventilations-Perfusions-Verhältnisses nach Lungentransplantation durch die Anwesenheit einer erkrankten Lunge -wie dies in der klinischen Situation der Fall ist -negiert und diesen Umstand in seinen tierexperimentellen Untersuchungen an Hunden mit Lungenemphysem bewiesen.Heruntergeladen von: National University of Singapore. Urheberrechtlich geschützt.