Thesis Erasmus University Rotterdam. / ook verschenen in gedrukte versie. With bibliogr., with a summary in Dutch.

Thesis Erasmus University Rotterdam. / Auteursnaam op omslag: Bart Janssen. ook verschenen in gedrukte versie. With bibliogr., with a summary in Dutch.

Thesis Erasmus University Rotterdam. / ook verschenen in gedrukte versie. With bibliogr., with a summary in Dutch.

Σκοπός της μελέτης ήταν να εξετάσουμε, σε ένα πειραματικό μοντέλο πειραματικής ηπατεκτομής (70%) αφ’ ενός και παροδικής απόφραξης του ηπατοδωδεκαδακτυλικού συνδέσμου (χειρισμός Pringle) αφ’ ετέρου, το φαινόμενο της βακτηριακής μετακίνησης, της ενδοτοξιναιμίας, καθώς και τις μεταβολές οι οποίες συμβαίνουν στην εντερική χλωρίδα και τον εντερικό βλεννογόνο. Σε αυτά τα δύο μοντέλα προσπαθήσαμε κατ’ αρχήν να πιστοποιήσουμε την αυξημένη μετακίνηση των εντερικών βακτηρίων στους μεσεντέριους λεμφαδένες και την διαπίδυση ενδοτοξινών από τον αυλό του εντέρου στην πυλαία και την αορτή. Στα ίδια μοντέλα προσπαθήσαμε να αναστείλουμε τα ανωτέρω φαινόμενα με φαρμακολογικούς χειρισμούς, μελετώντας πρώτον τη χορήγηση λακτουλόζης από το στόμα, η οποία έχει την ικανότητα να δεσμεύει την ενδοτοξίνη και να σχηματίζει σύμπλεγμα που δεν απορροφάται από το έντερο, με σκοπό τη μείωση της ενδοαυλικής απορροφήσιμης ενδοτοξίνης και δεύτερον τη χορήγηση δυσαπορρόφητων αντιβιοτικών από το στόμα, με σκοπό την ποσοτική ελάττωση του πληθυσμού της μικροβιακής χλωρίδας στον αυλό του εντέρου. Τα αποτελέσματα κάθε φάσης της μελέτης της ηπατεκτομής (70%) και του χειρισμού Pringle είχαν ως εξής: Η ηπατεκτομή (70%), προάγει την εντερική βακτηριακή μετακίνηση στους μεσεντέριους λεμφαδένες και στο ήπαρ, αυξάνει την ενδοτοξιναιμία και επιφέρει ιστολογικές αλλαγές στο ύψος των λάχνων. Η χορήγηση λακτουλόζης δημιουργεί τις κατάλληλες συνθήκες που επιφέρουν την μείωση των θετικών καλλιεργειών ιδιαίτερα αυτών του ήπατος και ελαττώνει την ενδοτοξίνη στην πυλαία. Η αποστείρωση του εντέρου με τη χορήγηση δυσαπορρόφητων αντιβιοτικών, μειώνει την εντερική βακτηριακή μετακίνηση στους μεσεντέριους λεμφαδένες και την ενδοτοξιναιμία. Ο χειρισμός Pringle, προάγει την εντερική βακτηριακή μετακίνηση και την ενδοτοξιναιμία, ενώ η απόπτωση ελαττώνεται με την αποστείρωση του εντέρου και τη χορήγηση λακτουλόζης μόνο άμεσα μετά τον χειρισμό. Η εξασφάλιση της ανατομικής και λειτουργικής ακεραιότητας του εντερικού βλεννογόνου έχει ιδιαίτερη σημασία στη διατήρηση του βλεννογόνιου εντερικού φραγμού και αποτρέπει την ενδοτοξιναιμία και τη βακτηριακή μετακίνηση. Η αποκατάσταση της δομικής και λειτουργικής ακεραιότητας του εντερικού βλεννογόνου, στην εκτεταμένη ηπατεκτομή, με τη χορήγηση μη απορροφήσιμων αντιβιοτικών και λακτουλόζης, αναστέλλει σημαντικά τα ανωτέρω φαινόμενα. / The purpose of this study is to investigate on an experimental model of extended hepatectomy(70%) and temporary occlusion of the hepatoduodenal ligament (Pringle maneuver), the phenomenon of bacterial translocation, endotoxaemia as well as the changes that are taking place, both in the intestinal flora and intestinal mucosa. In both models we attempt to demonstrate the increase translocation of intestinal bacteria to mesenteric lymph nodes (MLNs) and increase of endotoxin in the systemic and portal circulation. Using the same models, we attempted to inhibit the above phenomena with pharmacological manipulation. We examined the decrease of the endotoxins translocation, by administering per.os lactulose, which has the property to bind the endotoxin formatting a nonabsorbable comlex in the gut lumen. We also investigated the effect of nonabsorbable antibiotics per. os on reducing the intestinal flora. Our results indicated that, extended hepatectomy (70%) increased translocation of intestinal bacteria to mesenteric lymph nodes and liver and increased the endotoxaemia inducing the decrease of intestinal villus height. The administering of lactulose created the proper conditions which decreased positive liver cultures and reduced the endotoxin concentrations in portal blood. Gut decontamination by administration of nonabsorbable antibiotics reduced the intestinal flora, the intestinal bacteria translocation to MLNs and endotoxaemia. Pringle maneuver promoted the intestinal bacterial translocation and endotoxaemia. Apoptosis decreases, by gut decontamination and administration of lactulose only immediately after Pringle maneuver. The anatomic and functional integrity reassurance, of intestinal mucosa, has strong significance for the preservation of intestinal mucosal barrier to prevent endotoxaemia and bacterial translocation. The structural and functional establishment of enteric mucosa integrity, after extended hepatectomy, by administration of nonabsorbable antibiotics and lactulose, inhibit considerably the above phenomena.

Thesis (S.T.D.)--Catholic University of America, 1933. / Bibliography: p. 140-146.

Thesis (S.T.D.)--Catholic University of America, 1933. / Bibliography: p. 140-146.

This dissertation offers an extended examination of the writing of the 1820 Scottish settler Thomas Pringle. Though the primary focus of analysis is Pringle's poetry, the dissertation also engages extensively with Pringle's prose writing, particularly the Narrative ofa Residence in South Africa (1834), as well as the archival records of his personal and official correspondence. As the title suggests, the dissertation works through three distinct periods of Pringle's life, in each of which it locates different but related colonial postures or dispositions. In this schema, Pringle's Scottish writing is understood as obeisant to British cultural and linguistic norms, which it reproduces in a fashion that may be considered colonial in its deference to metropolitan standards. The Scottish context also provides Pringle with examples of people considered marginal to the developing modernity of the Scottish state (such as gypsies), who provide, I argue, baseline models for how Pringle will come to represent colonised indigenous peoples. In addition, the general principles of Scottish Enlightenment thought, in particular the four stages theory of historical development, supplied Pringle with a model within which to conceptualise the colonial state and its future evolution. Chapters two and three focus on Pringle's colonial career in the Cape Colony. Here I argue that Pringle's poetry of this period provides evidence of two distinct phases. In the first and most difficult period of settlement Pringle wrote poetry of troubled lyric interiority which reflected an incommensurable gap between colonial experience and the expressive expectations and conventions which he brought to it. Following his fallout with Governor Somerset and a de facto alliance with the mission humanitarians, Pringle's poetry moves away from a Romantic preoccupation with the self and begins to engage larger public issues, such as the treatment of indigenous people. In this mode, Pringle very often assumes an indigenous persona and I examine the extent to which such a gesture might be considered both appropriative and incipiently transcultural. As indicated earlier, I also examine the generic and representational models which might have informed Pringle's treatment of this subject. The chapters also consider Pringle's colonial politics, and emphasise that his reputation as a 'radical' is a misleading one; there are, furthermore, no easy conjunctures to be established between Pringle's allegedly radical politics and a radicalism of representation in his poetry (a commonplace critical assumption). In the final chapter I examine the complexities of Pringle's London years, which require that we bring into focus both his Scottish and his South African experience and their mediation by this new context. Here the broad focus of my argument is that we must take account not only of Pringle's standing as an abolitionist-humanitarian and Secretary to the high profile Anti-Slavery Society, but also his position as a respectable man of letters, particularly his role as editor of the influential but genteel 'annual', Friendship's Offering, from 1829-1835. These dual public roles reciprocated one another, I argue, in that Pringle's reputation as a poet of 'elegance' and 'taste' also lent credence to his reputation an ethically exemplary humanitarian. This reciprocation of roles is strongly evident in Pringle's best known poems of this period, «The Bechuana Boy" and «The Emigrant's Cabin", which rewrite colonial experience in a way that conforms to the expectations of his metropolitan readers. During his residence in London, Pringle also produced a number of poems in the subgenre of what could be described as evangelical redemptivism. These hortatory and proselytising pieces were mainly published in missionary magazines, and though South African in subject matter they could equally be set in any area of empire where mission work was being done. This subgenre I analyse as an offshoot of the extreme evangelical and abolitionist enthusiasms of the 1830s, with their belief in their divinely mandated mission to fully Christianise the British empire and emancipate all its subjects. In conclusion, this study argues for an understanding of Pringle's work as being intersected by differences in imperial location and status, as well as by a significant degree of instability and contradiction in its representation of the colonial project. Far from being cohered around a teleological liberal vision of an emancipated future, Pringle's work, both prose and poetry, repeatedly reveals a contradiction and contrariety that suggests fundamental irresolution rather than firm conviction. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2008.

Lowering of central venous pressure in hepatic surgery is nowadays widely recommended and used procedure. Low central venous pressure anesthesia is associated with decreased blood loss and improved clinical outcome. There are several approaches how to reach low central venous pressure. Till now none of them is recommended as superior in terms of patient safety and clinical outcome. Concurrently there is still debate if to use the low central venous pressure anesthesia principle or if it could be replaced with a principle of anesthesia with high stroke volume variation (or another dynamic preload parameter) with the use of a more sophisticated hemodynamic monitoring method. Results of our study didn't show any significant difference between two approaches used for reduction of central venous pressure, but suggest that the principle of low central venous pressure anesthesia could be possibly replaced by the principle of high stroke volume variation anesthesia which presumes the use of advanced hemodynamic monitoring. KEYWORDS Hepatic resection, central venous pressure, Pringle maneuver, hemodynamics, hemodynamic monitoring, fluid therapy, anesthesia

Lowering of central venous pressure in hepatic surgery is nowadays widely recommended and used procedure. Low central venous pressure anesthesia is associated with decreased blood loss and improved clinical outcome. There are several approaches how to reach low central venous pressure. Till now none of them is recommended as superior in terms of patient safety and clinical outcome. Concurrently there is still debate if to use the low central venous pressure anesthesia principle or if it could be replaced with a principle of anesthesia with high stroke volume variation (or another dynamic preload parameter) with the use of a more sophisticated hemodynamic monitoring method. Results of our study didn't show any significant difference between two approaches used for reduction of central venous pressure, but suggest that the principle of low central venous pressure anesthesia could be possibly replaced by the principle of high stroke volume variation anesthesia which presumes the use of advanced hemodynamic monitoring. KEYWORDS Hepatic resection, central venous pressure, Pringle maneuver, hemodynamics, hemodynamic monitoring, fluid therapy, anesthesia