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Biomedical subjects

A Thiede

Publications and source records attributed to A Thiede.

At least 127 records · Page 7Linked to original sources
PubMed1998

Apoptosis of T lymphocytes in liver and/or small bowel allografts during tolerance induction.

BACKGROUND: Apoptosis of parenchymal cells has been described during allograft rejection. Immunologically privileged tissue in the mouse has been found to prevent rejection by initiating apoptosis of infiltrating lymphocytes. The aim of this study was to investigate whether apoptosis may play a role in T-cell regulation during rejection and subsequent tolerance induction after liver transplantation (LTx) and combined liver/small bowel transplantation (LSBTx). METHODS: LTx and LSBTx (Brown Norway-->Lewis) were performed without immunosuppression. Cell migration, activation, and apoptosis were investigated by means of sequential histology, immunohistochemistry, and the terminal deoxynucleotidyl transferase-mediated dUTP-digoxigenin nick end labeling assay. Donor (Brown Norway) and third-party (Dark Agouti) cardiac allografts were transplanted into LSBTx recipients to determine specific tolerance. RESULTS: Transient acute cellular rejection occurred after LTx and LSBTx and was followed by specific tolerance. The kinetics of apoptosis were similar in liver allografts after LTx and LSBTx, but differed from the processes in small bowel allografts after LSBTx. Apoptosis of parenchymal cells in the grafted livers correlated directly with interleukin-2 receptor expression of the infiltrating T cells. During the late phase of rejection, a peak of apoptosis in the lymphocyte infiltrate was demonstrated, characterized as predominantly apoptotic CD8+ T lymphocytes. CONCLUSIONS: These results demonstrate that specific tolerance is achieved in both LTx and LSBTx after a transient rejection crisis. Apoptosis is involved in graft rejection and tolerance induction. Activation of T lymphocytes correlates with parenchymal cell apoptosis in the allograft. T-cell inactivation seems to result in apoptosis of cytotoxic T cells and tolerance, which appears to be unique to the liver allograft.

Animals↗
PubMed1998

Coloanal J-pouch reconstruction following low rectal resection.

From an oncological point of view, a distal resection border of 2 cm is sufficient after deep anterior rectal resection and total mesorectal excision. This conclusion has led to extending the indications for ultradeep rectal resection in recent years. The classical end-to-end coloanal anastomosis, however, has been shown to be associated with several functional drawbacks, for example, increased stool urgency and in some cases incontinence, especially in the first 6-12 months after the operation. It was to improve these aspects that the coloanal pouch was introduced. In a pilot study we performed a coloanal pouch in 25 patients (median age 65 years, range 32-85). The coloanal pouch anastomosis was generally performed by a stapling device. A transanal hand-sewn anastomosis was performed in the section down to the sphincter level. Indications included rectal cancer, recurrent villous adenoma, and in one case recto-vaginal fistula. The pouch was also constructed by a linear stapling device, and its length was usually 5-7 cm. The level of the anastomosis averaged 2 cm above the dentate line. In 16 patients a protective ileostomy was also carried out. We observed four cases of anastomotic leak and in one an abscess. Results showed full continence after 6 months and in 85% after 1 year. Urgency was observed in four patients after 3 months, and in only one after 1 year. In summary, we obtained encouraging results for initiating a randomized trial in the future to confirm the advantages of this type of reconstruction after deep anterior rectal resection.

Adult↗
PubMed1998

[Country-wide survey of therapeutic procedures in hemorrhoids and anal fissure].

A survey among coloproctologists was performed to assess current therapeutic concepts for the treatment of hemorrhoidal disease and anal fissure. A total of 261 clinical and non-clinical proctologists participated, representing the entire range of therapies in hospital and practise. A wealth of widely differing, in some aspects contradictory concepts were recorded, leaving almost no subject entirely undisputed. There are controversies regarding the different therapeutic alternatives as well as indications for surgery and choice of operative procedure. Future research has to address the existing controversies in order to reach a higher degree of standardization in the therapy of these common proctological disorders.

Colorectal Surgery↗
PubMed1998

Overview on compression anastomoses: biofragmentable anastomosis ring multicenter prospective trial of 1666 anastomoses.

This study represents a European prospective clinical multicenter trial and was undertaken to evaluate the applicability of the biofragmentable anastomosis ring (BAR) as a routine anastomotic tool in teaching hospitals. The trial results analyzed consisted of 1666 BAR anastomoses performed in 1360 patients from March 1989 to May 1996 in the upper (1042 anastomoses) and lower (624 anastomoses) gastrointestinal (GI) tract. Only patients selected for elective procedures and having previously undergone orthograde bowel cleansing were entered into the trial. In the upper GI tract six anastomoses (0.58%) developed clinically relevant and radiologically detectable leaks with indications for reoperation. In the lower GI tract 42 (6.73%) anastomoses showed a radiologically detectable leak with clinical manifestations in 28 cases (4.48%). Reoperation was performed in 18 cases (2.80%). The overall leakage rate with clinical relevance was 2.04%. Three gastrojejunostomy episodes of bleeding were observed (0.18%) at the BAR anastomotic site. During the early postoperative course there was no ileus due to obstruction of a BAR anastomosis. Reintroduction of diet after the operation was not delayed. In two centers a follow-up evaluation reported no BAR-related late anastomotic stenoses. There were no intraoperative deaths, but 54 patients died postoperatively. Peritonitis following anastomotic leakage was responsible for postoperative deaths in four cases; three of them were related to BAR anastomoses. In conclusion, the BAR anastomotic procedure is an established, rapid, simple to learn, highly standardized, safe technique with the advantage of no persistent foreign material in the anastomotic region and therefore no induction of stenosis. At present, the application of anastomoses in various segments of the GI tract, from the stomach to the middle third of the rectum, can be recommended.

Adolescent↗
PubMed1998

Inter- and intraindividual reproducibility of anorectal manometry.

BACKGROUND: This study investigates the inter- and intraindividual variability of normal values and, thus, the reproducibility of anorectal manometry. MATERIALS AND METHODS: Following a standardized protocol, three anorectal manometries were performed 4 h apart on 2 days of investigation, with an interval of 4 weeks, in ten healthy volunteers. Measured parameters in all 60 manometries were: sphincter length (SL), resting pressure (RP), maximum squeeze pressure (MSP), relaxation of the internal anal sphincter (RIAS), and rectal compliance (RC). Interindividual variability was expressed as standard deviation from calculated mean values and intraindividual variability was tested with Wilcoxon's test for tied samples and Spearman's rank correlation test. RESULTS: A large interindividual variability was found for all measured parameters, except for SL, reflecting the extensive absolute range of measured values. Median intraindividual variability among the six individual measurements and between both measurement days revealed that MSP, RIAS and RC are parameters which were not reproducible in this volunteer study. A significant correlation between the results of the repetitive measurements and, thus, a good reproducibility was only found for the parameters SL and RP. CONCLUSIONS: Anorectal manometry has only limited diagnostic value; although rather exact quantifications of individual parameters can be achieved, the impact of these measurements should be regarded rather critically, since only SL and RP appeared to be reproducible parameters.

Adult↗
PubMed1998

Quality of life in patients with benign anorectal disorders.

BACKGROUND: Benign proctological conditions are very common in Western civilization. However, to date quality of life in these patients has not been evaluated comprehensively. The aim of this study was to investigate whether the Gastrointestinal Quality of Life Index (GIQLI) is a useful instrument for measuring quality of life in these patients, and subsequently to establish baseline values for different anorectal disorders. METHODS: The questionnaire was completed by 325 consecutive patients (182 men; mean age 49 years) seen at the proctology outpatient clinic. For further analysis patients were classified into nine subgroups according to the primary diagnosis: group 1, haemorrhoids (n=96); group 2, anal fissure (n=38); group 3, fistula in ano (n=22); group 4, severe constipation (n=14); group 5, faecal incontinence (n=35); group 6, symptomatic anterior rectocele (n=12); group 7, perianal abscess (n=7); group 8, perianal thrombosis (n=7); and group 9, miscellaneous conditions (e.g. skin tags, anal papillomas, mild constipation, rectal polyps) (n=94). The GIQLI scores were compared between the subgroups. In addition the GIQLI scores of age-matched healthy controls, derived from data in the literature, were compared with the patients' scores. RESULTS: The mean GIQLI score for all patients was 113 (78.5 per cent of the maximum score of 144). Mean scores for the nine diagnostic subgroups were: group 1, 120; group 2, 104; group 3, 119; group 4, 94; group 5, 93; group 6, 112; group 7, 115; group 8, 129; and group 9, 117. Age-matched controls from a series published previously had a significantly higher GIQLI score compared with all patients (P < 0.0001). However, only the subgroups of patients with miscellaneous conditions, fissures, severe constipation and faecal incontinence had a significantly poorer quality of life than age-matched healthy individuals. CONCLUSION: The GIQLI is a valuable instrument for measuring quality of life in patients with benign anorectal disorders. Although certain diseases do not seem to affect quality of life profoundly, certain subgroups of patients, most notably those with incontinence and severe constipation, are extremely compromised. Severely constipated individuals exhibit the same poor quality of life as patients with faecal incontinence.

Adolescent↗
PubMed1998

Application of the new classification for cancer of the cardia.

BACKGROUND: Cancer of the cardia is now topographically classified into three types: type I, with the tumor center in the distal esophagus treated with subtotal esophagectomy; type II, arising at the gastroesophageal junction and treated with distal esophagectomy and either proximal or total gastrectomy; and type III, subcardial cancer treated with extended total gastrectomy. Our objective was to review the new classifications and compare the outcomes in patients grouped and treated according to these classifications. METHODS: Seventy-four patients with cancer of the cardia--15 with type I, 30 with type II, and 29 with type III cancer--underwent surgical resection at our institution between 1992 and 1997. Postoperative complications, UICC stages, and survival (Kaplan-Meier) were compared. RESULTS: The majority of patients with type I (73%) or type II (53%) cancer had stage I or II tumors, but only 27% of patients with type III cancer had this tumor stage (P < .05). Overall 30-day mortality was 4% and morbidity was 31%. Curative resections were performed in 73% (54 of 74) of the patients with 3-year survival rates of 72% (type I), 68% (type II), and 61% (type III). CONCLUSION: The recommended therapy for the different types of cancer of the cardia results in acceptable morbidity, mortality, and survival rates.

Adenocarcinoma↗