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Biomedical subjects

A Fürst

Publications and source records attributed to A Fürst.

At least 19 recordsLinked to original sources
PubMed2003

[Primary midline closure after excision of a pilonidal sinus is associated with a high recurrence rate].

BACKGROUND: There is a high incidence of postoperative complications and late recurrences after operative therapy of a pilonidal sinus. The optimal treatment strategy is still matter of discussion. We studied the long-term results after excision of a pilonidal sinus and primary midline closure compared with the open surgical procedure. MATERIALS AND METHODS: A total of 73 patients (62 male and 11 female, mean age 26.6 years) underwent a total of 79 operations between 1992 and 2001. Thirty patients (38%) were previously operated on because of a pilonidal sinus.Twenty-four were treated in our institution by an open procedure (five after simple abscess incision, 19 after sinus excision) and 52 by primary midline closure. Another three patients received skin flap procedures. RESULTS: Follow-up was possible for 65 patients (82%) for a median of 50 months.Recurrent pilonidal sinus occurred in 22 cases: 18 after primary midline closure (42%) and four after open procedure (21%, P=0.4). We found no relapse following the three skin flap procedures. There was a significantly higher relapse rate in patients operated with recurrent disease (12/25 vs 10/40; P<0.05). CONCLUSIONS: Despite of numerous previously operated patients (38%), there was a high recurrence rate (42%) after excision of a pilonidal sinus and primary midline closure. Alternative operative techniques creating a lateral wound or the various skin flap procedures may be promising alternatives. We are in the process of changing our treatment strategy for patients suffering from a pilonidal sinus.

Abscess↗
PubMed2002

[Effects of housing, feeding and use on equine health with emphasis on respiratory and gastrointestinal diseases].

In a random population of Swiss horses 54% suffered from a subclinical to moderate COPD. Cause of a COPD is a hypersensitivity of the respiratory tract to spores of fungi and thermophil actinomyces. Teeth problems are strongly associated with the type of diet and the feeding regime. Problems of the teeth belong to the most often treated equine diseases by large animal practitioners. Racehorses are the population of horses most often affected by gastric ulcers with an ulcer prevalence between 63 and 90%. In contrast, a much lower prevalence (37%) of stomach ulcers is seen in pleasure horses and the degree of ulceration is less severe. Large amounts of concentrated high-energy feeds, small rations of forage and a low feeding frequency per day as well as the use of spoiled food can contribute to the development of colics.

Animal Feed↗
PubMed2001

[Endoscopic fluorescence diagnosis of esophageal carcinoma after sensitization with 5-aminolevulinic acid].

BACKGROUND: Barrett's esophagus is a complication of gastroesophageal reflux disease (GERD) characterized by specialized columnar epithelium that contains goblet cells and replaces the squamous epithelium of the distal esophagus. It is found in about 10% of patients with symptomatic reflux disease and more importantly has been associated with the development of esophageal cancer. Adenocarcinoma arises from dysplasia, which is usually not visible during routine endoscopy, therefore extensive random sampling of the entire Barrett's segment should be performed with biopsies in the 4 quadrants every 1 to 2 cm and of any macroscopic abnormality. CASE REPORT: We report the history of a 60-year-old man who was admitted to hospital because of an ulcer in Barrett's esophagus not healing despite conservative treatment. He has suffered from gastroesophageal reflux disease for more than 30 years and an antireflux surgical procedure had not resulted in regression of Barrett's esophagus. However, close surveillance could not reveal any dysplastic or malignant lesion. Endoscopic fluorescence detection (EFD) after sensitization with 30 mg/kg 5-aminolevulinic acid (5-ALA) in this patient demonstrated a selective red fluorescence in a macroscopically normal appearing area near the already known ulcer. Biopsies from this fluorescent area showed an adenocarcinoma. Esophagectomy confirmed the presence of intramucosal adenocarcinoma without lymph node metastases.

Adenocarcinoma↗
PubMed2001

Dynamic magnetic resonance imaging defecography: a diagnostic alternative in the assessment of pelvic floor disorders in proctology.

PURPOSE: Standard diagnostic proctologic procedures in the assessment of pelvic floor disorders include clinical evaluation and endoscopy. Particular aspects of combined pelvic floor disorders, especially those involving more than one pelvic compartment, may remain undetected without additional technical diagnostic procedures such as videoproctoscopy, cinedefecography, or colpocystodefecography. The aim of the study was to review the potentials of dynamic magnetic resonance imaging defecography to elucidate the underlying anatomic and pathophysiologic background of pelvic floor disorders in proctologic patients. PATIENTS AND METHODS: Dynamic magnetic resonance imaging defecography was performed in 20 Patients (13 females) with main diagnoses such as rectal prolapse or intussusception, rectocele, descending perineum, fecal incontinence, outlet obstruction, and dyskinetic puborectalis muscle after clinical evaluation. The investigation was performed on a 1.5 T-magnetic resonance imaging machine in supine position. The rectum was filled with Gd-DTPA enriched ultrasound gel. First a T1/T2 weighted investigation of the pelvis was performed, followed by defecography with evacuation of the rectum. Images were obtained in a sagittal plane in a frequency of 1 image/second (true FISP) at rest and during straining. The obtained magnetic resonance imaging video tapes were analyzed off-line with cinematographic evaluation of bladder base, uterus, and anal canal position in relation to the pubococcygeal line by a blinded radiologist. Investigation time was 20 minutes. RESULTS: In dynamic magnetic resonance imaging defecography of the pelvic floor, 12 patients with descending perineum, 10 rectoceles (10 females), 6 cystoceles (6 females), 4 enteroceles (4 females), 8 intussusceptions (5 females), and a dyskinetic puborectalis muscle in 3 males were detected. In 11 females and 3 males multifocal disorders were found, involving more than one compartment in females, whereas in males complex defects were restricted to the posterior compartment. Magnetic resonance imaging defecography revealed diagnoses consistent with clinical results in 77.3 percent and defects in addition to clinical diagnoses in combined pelvic floor disorders in 34 percent. CONCLUSIONS: In complex pelvic floor disorders, involving more than a single defect, dynamic magnetic resonance imaging represents a convenient diagnostic procedure in females and to a lesser extent in males, in particular in terms of dynamic imaging of pelvic floor organs during defecation. In addition to the clinical assessment, dynamic magnetic resonance imaging had clinical impact in proctologic and interdisciplinary treatment.

Adult↗
PubMed2001

[Dynamic MR defecography for diagnosis of combined functional disorders of the pelvic floor in proctology].

PURPOSE: Evaluation of magnetic resonance defecography in the diagnosis of pelvic floor disorders were examined prospectively. MRI was performed on a 1.5 T scanner. The rectum was opacified with 200 ml of ultrasound transmission gel. A sagittal single section T2-weighted gradient echo sequence with a temporal resolution of 1.1 second was performed. Changes of the anorectal angle and the position of the pelvic organs in relation to the pubococcygeal line were registered at rest, during straining, and during evacuation of the rectum. RESULTS: Patients with obstructed defecation (n = 15) showed prolapse of the rectal mucosa (n = 5), anterior rectocele (n = 8), pelvic floor descent (n = 5), enterocele (n = 2), and anorectal dyscoordination (n = 3). Individuals with stool incontinence (n = 15) had an anterior rectocele (n = 10), pelvic floor descent (n = 11), enterocele (n = 2), prolapse of rectal mucosa (n = 1), and a puborectal insufficiency (n = 1). Urine incontinence was associated with cystocele (n = 10) or normal findings (n = 4). In patients with unspecific symptoms (n = 6), anorectal dyscoordination (n = 4) and prolapse of the rectal mucosa (n = 2) were found. MRI was superior for the detection of enteroceles, cystoceles and pelvic floor descent compared with clinical investigation. CONCLUSION: Dynamic MR imaging supplies complex information in anorectal disease and thus improves proctoscopy.

Adolescent↗
PubMed2000

[Coloproctological diseases of the pelvic floor].

PURPOSE: The aim of this review is to describe the most frequent and important coloproctologic pelvic floor disorders. Relevant diagnostic procedures of the pelvic floor will be presented. MATERIAL AND METHODS: A host of diagnoses and symptoms such as the descending perineum syndrome, rectocele, cystocele, enterocele, uterine and vaginal descensus, anal and rectal prolapse, outlet obstruction, anismus, inertia recti and intussusception are included under the heading "pelvic floor disorders". Although symptoms are often varied, problems concerning urinary and/or faecal continence commonly lead to primary consultation of a physician. RESULTS: Quite often, apparently divergent symptoms such as constipation and incontinence are simultaneously mentioned. A clear gender disposition is observed with female patients inflicted nine-fold in comparison to male patients. The primary consultant may belong to a variety of specialities such as urology, proctology, gynaecology or dermatology, depending upon the predominant symptom. A feeling of trust is essential for the treatment of a disorder involving highly intimate regions of the body. DISCUSSION: An exact medical history and standardized proctologic evaluation consisting of inspection, palpation, rectoscopy and proctoscopy may be augmented by investigations such as anorectal manometry or endosonography. Conventional defecography has been replaced more and more by dynamic MRI of the pelvic floor in specialized institutions, enabling additional gynaecologic and urologic investigations avoiding ionizing radiation.

Colonic Diseases↗
PubMed2000

[Significance of inter-sphincter rectal resection with colo-anal anastomosis in deep seated rectal carcinoma].

From October 1992 to December 1996, 204 patients with rectal cancer were treated with tumor resection. Of all carcinomas 94 were localised in the distal, 71 in the middle and 39 in the proximal third of the rectum. Curative resection could be achieved in 74% to 85% of the cases depending on tumor localisation. A local R0-resection (no residual tumor) was achieved in 92% to 100%, partly due to preoperative radiochemotherapy in cases of locally advanced cancer. The percentage of protective stoma application ranged from 25% of the total number of resections to 89% in those cases with intersphincteric rectal resection. The peri- and postoperative complications were thoroughly documented. The number of complications increased with the distal extent of rectal resection. The median follow up period was 24.5 months. Local tumor recurrence was observed in 6 cases (3.1%) independent of the tumor location. Distant metastasis was seen in 16% of all patients during the follow up period. 73% of all patients are still alive, 23% died of tumor related and 4% of non tumor related reasons. Complete postoperative stool continence was reported by 73% of all patients, 14% were incontinent for liquid stool and 13% were affected by total stool incontinence. Excluding those who underwent rectum extirpation, 39% of the patients had a stoma. The extent of stool continence was closely related to the operative procedure. With intersphincteric resection, complete stool continence could only be achieved in 40% of the patients whereas 18% were incontinent for liquid stool, 14% were completely incontinent and 29% had a stoma at the time of observation. The rate of local recurrence was not increased after intersphincteric resection.

Adult↗
PubMed2000

Esophageal obstruction in horses: a retrospective study of 34 cases.

The major purpose of this investigation was to describe the causes, possible complications, and prognoses of horses with esophageal obstruction. Of 34 cases presenting with esophageal obstruction, 28 cases were due to impaction of ingesta. Obstruction due to pre-existing esophageal disease occurred in 4 horses with megaesophagus, in 1 horse with stricture in the upper third of the esophagus, and in 1 horse with esophageal diverticulum. There was no significant difference in the contamination of the trachea between horses that subsequently developed aspiration pneumonia and those that did not. The duration of esophageal obstruction prior to admission was significantly longer in horses that developed aspiration pneumonia (median 18, range 2-48 h) than in those horses that did not (median 4, range 0.5-48 h). Although the obstruction was relieved in all 34 horses, 4 were euthanized because of recurring obstruction due to megaesophagus (n = 2), esophageal diverticulum (n = 1), and esophageal stricture (n = 1).

Animals↗
PubMed1999

The human apM-1, an adipocyte-specific gene linked to the family of TNF's and to genes expressed in activated T cells, is mapped to chromosome 1q21.3-q23, a susceptibility locus identified for familial combined hyperlipidaemia (FCH).

The human adipocyte-specific apM-1 gene encodes a secretory protein of the adipose tissue that has been suggested to play a role in the pathogenesis of obesity. The regulation of apM-1 was studied along adipocyte differentiation. While apM-1-mRNA and apM-1 protein were absent in preadipocytes and in 48 h differentiated adipocytes, they were found upregulated from day 4 to day 9 of adipocyte differentiation as shown by RNase protection assay and Western blot analysis. These data indicate that apM-1 may be a late marker of adipocyte differentiation. In human sera apM-1 protein is also detectable by Western blots using a polyclonal antibody raised against a synthetic peptide sequence of the human apM-1. The genomic structure of the human apM-1 gene together with a total of 2.7 kb of the 5'-flanking region with putative transcription factor binding sites is presented. Interestingly, sequence comparisons link the apM-1 gene to the family of TNF's and to genes expressed in activated T-cells. The chromosomal localization of apM-1 was investigated by FISH and mapped to human chromosome 1q21.3-1q23, a region that was identified as a susceptibility locus for Familial Combined Hyperlipidaemia (FCH) and polygenic NIDDM. These data and the chromosomal localization on chromosome 1q21.3-q23 raises the possibility that apM-1 as an adipocyte-specific secretory protein may play a role in the pathogenesis of FCH and associated insulin resistance. Exon- and intron-specific primer sequences are presented as a basis for mutation screening of patients affected with FCH.

3T3 Cells↗
PubMed1999

["Cardiomegaly and pneumonia"--a misdiagnosis in long-standing achalasia].

HISTORY: A 65-year-old woman was admitted to another hospital with suspected status asthmaticus. While there was progressive respiratory failure, the chest X-ray showed bilateral congestion and infiltration with widened mediastinum and cardiomegaly. The patient was transferred to the authors' hospital after two days on ventilatory support because of suspected left-ventricular failure and pulmonary congestion with pneumonia. 30 years previously she had undergone a myotomy for achalasia. INVESTIGATIONS: Imaging of the oesophagus with water-soluble contrast medium, computed tomography of the thorax and gastroscopy revealed a siphon-like megaoesophagus (which had been misinterpreted radiologically as cardiomegaly) with a slightly open lower oesophageal sphincter. The pulmonary symptoms were thought to be due to aspiration pneumonia. TREATMENT AND COURSE: As there were no other reasonable treatment options a transmediastinal oesophageal resection with gastric pull-through and collar anastomosis was performed. CONCLUSION: In long-standing achalasia a megaoesophagus can develop despite previous myotomy. It should be included in the differential diagnosis of radiologically demonstrated mediastinal enlargement.

Aged↗
PubMed1993

[Experiences with long-term intravenous therapy using teflon catheters in 80 horses].

In a retrospective study the tolerance to Teflon coated catheters in long-term intravenous medication was evaluated in 80 horses. Catheters were inserted into the jugular vein and remained there for 3 to 30 days (average 8.6 days). Catheters were flushed using an heparinized solution after each medication administration. The site of catheter placement was evaluated daily for swelling, pain and venous distensibility respectively. Swelling at the site of insertion was noted in 10 horses, a small subcutaneous abscess formation was identified in one horse. Fourteen sonographic evaluations were performed on 10 horses, demonstrating perivascular changes in four. Thrombus formation did not occur. In all horses the catheter could be identified floating freely within the vascular lumen. Catheter failure occurred in nearly a third of all cases either as a result of mechanical failure or of pull-out by the horse. After removal of the catheter no adverse side effects attributable to the mode of medication were noted in any of the horses. In conclusion, intravenous medication using Teflon-coated catheters is a suitable alternative to other modes of administration.

Abscess↗
PubMed1984

[Brain injuries in skiers].

During the last skiing season (November 1981 to March 1982), 33 patients were treated for craniocerebral injuries caused by skiing accidents. Based on the classification made by Tönnis und Loew, 11 patients had grade I, 11 patients grade II and 11 patients grade III (including 3 open craniocerebral injuries). Four patients underwent operation for intracranial hematoma. Out of 33 patients 79% recovered completely. One patient has a permanent neurologic defect, two patients have an apallic syndrome and four died.

Adolescent↗