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Biomedical subjects

F Stelzner

Publications and source records attributed to F Stelzner.

At least 19 recordsLinked to original sources
PubMed1992

[Sequential cancer of concomitant cancer?].

The generally-favoured polyp-cancer sequence hypothesis its probably wrong. The distribution of polyps in large intestine differs from that of cancer. There is evidence that different aetiological factors are involved in the genesis of polyps, their growth rate and the development to invasive cancer. Most polyps are very small (90%). They never develop a cancer. It is a diffusely abnormal state of the large bowel mucosa which renders it more liable to produce often polyps and very rare carcinoma (5%). Polyp-carcinoma concomitance is much nearer to the truth.

Cell Transformation, Neoplastic↗
PubMed1992

[Anatomically-induced diagnostic and technical surgical problems and complications in surgery of the anorectum].

Preservation and reconstruction are the key principles for surgical therapy of the anorectal organ of continence. The occlusive strength of the sphincter system varies significantly among individuals. As a rule, women have weaker sphincter muscles than men. Both sexes experience a decrease in sphincter strength with age. The physiological weakness of the anorectal sphincters in females is explained by a relatively smaller amount of sphincter muscle mass and an asymmetric sphincter anatomy which is characteristic for the female pelvic floor. In addition, the spinal centers controlling continence are structurally less complex in women than in men. Chronic constipation and the stress of vaginal deliveries frequently cause damage to the pelvic floor in women by overstretching muscular elements. They appear to play a leading role in the development of spontaneous incontinence, a condition occurring exclusively in women. Preoperative assessment of sphincter strength can be accomplished easily by using a very simple measuring device described earlier. Sphincter pressure measurements are felt to be an essential part of any preoperative work-up in anorectal surgery. The numerous procedures described for reconstructing anorectal sphincter function in patients with incontinence are symbolic operations which at the most create an illusion of continence. Narrowing the levator muscles with plastic bands may improve continence if there is some residual sphincter musculature which is still functional. But it will never cure anorectal incontinence. Recommendable procedures for treatment of anorectal prolaps, anorectal fistulas, and hemorrhoids are discussed. Operative treatment of hemorrhoids which are caused by hyperplastic enlargement of parts of the corpus cavernosum recti is also associated with a greater risk of incontinence in women than in men.

Aged↗
PubMed1992

[Foundation, technique and results of short continence resection in rectal cancer].

Ultra-short resections of the rectum have been recommended for rectal carcinomas extending to lower than eight cm from the dentate line in order to preserve anal continence. Resection of the main lymphatic pathways together with the adjacent lamellae is important for radical removal of all tumour cells. Valves in the rectal lymph vessels allow lymph fluids to drain only in a cranial direction. There are no lymph nodes behind the dorsal adjacent lamella. Thus, a distal margin of two cm from the tumour is sufficient to minimize the risk of recurrence. We recommend a transano-abdominal approach for very low rectal carcinomas. During the past years, we have operated on 241 patients with rectal carcinomas and found five-year-survival rates of 54 percent with rectum resections with colostomies, 67 percent with low anterior resections and 75% with ultra-short sphincter preserving resections.

Anastomosis, Surgical↗
PubMed1992

[Hemorrhoidectomy--a simple operation? Incontinence, stenosis, fistula, infection and fatalities].

Hemorrhoidectomy is not a simple procedure. Hemorrhoids develop as hyperplastic formations of an important part of the anorectal organ of continence, i.e., the corpus cavernosum recti. This organ segment is analogous to tissue structures found in the tongue of certain birds which are used for hulling seeds. Well-meaning, complete resection of the corpus cavernosum will inevitably result in incontinence. Only operative techniques which resect exclusively those segments of the hemorrhoidal tissue adjacent to the muscle layer in the anal canal are adequate. These procedures will spare sufficient tissue of the corpus cavernosum to allow a safe segmental resection of this structure and at the same time permanently eradicate the hemorrhoids. In the present paper, the treatment of 53 patients with postoperative incontinence and of others with stenoses, fistulas and pelvic infections is discussed. Fatalities have never been reported in the literature following operative hemorrhoidectomy, however, have occurred after "banding" procedures and after injection therapy.

Adult↗
PubMed1991

[Fascia skeleton of the abdominal cavity--hernia and anorectal incontinence].

The abdominal cavity is the most primitive body cavity. Its musculo-fascial skeleton encompasses the abdominal wall, the pelvic floor, and the diaphragm. Comparative anatomical studies have demonstrated remarkable homology in the muscular and fascial architecture of each of these structures. In addition, all muscular sheets lining the abdominal cavity display a characteristic resting tone enabling them to act as a single functional unit. During pregnancy and childbirth the abdominal wall and the pelvic floor are prone to impairment from overstretching. This damage may result in postpartum paralysis of the abdominal wall or anorectal incontinence. Insight in the special anatomic and physiologic features of the abdominal muscle sheets may lead to a better understanding of the pathogenesis of primary and secondary abdominal hernias as well as postpartum anorectal incontinence and may improve surgical treatment.

Abdominal Muscles↗
PubMed1991

[Conservative surgery].

Today the potentially dangerous aftereffects of surgical procedures such as shock or wound infection can be effectively prevented. The use of dissection technique which minimizes trauma to the surrounding tissues by means of a scalpel or electrocautery reduces the general impact of an operation. The use of atraumatic needles and modern, synthetic suture materials have decreased the incidence of wound infections significantly. Dissection along avascular fascial planes such as the adjacent lamellae allows the removal of large volumes of tissue without sequelae. Adjacent lamellae are special fasciae which enclose organs protectively.

Anastomosis, Surgical↗
PubMed1991

[Anorectal incontinence--cause and treatment].

The organ of continence shows sex-related differences. The female organ of continence is less high developed and therefore more susceptible to impairment. 90% of all patients with "spontaneous incontinence" are women. This can be explained by comparative anatomy. Pelvic floor and abdominal wall is a unit. They have an intrinsic permanent tone and this is on the pelvic floor the basis of continence. During delivery and from chronic obstipation pelvic nerve damage due to overextension occur frequently. The permanent tone is lost. The flabby abdomen and incontinence are therefore the result of such nerve overextension injuries. Our results of treatment in 120 patients are very good in traumatic lesions by direct sphincter suture. If the pelvic floor has retained some of its strength a circular silastic band can improve the effect of continence.

Anal Canal↗
PubMed1979

[Early diagnosis of ileus by the gastrointestinal passage of a resorbable contrast medium and of recurrent intestinal obstruction].

The differential diagnosis of paralytic ileus vs mechanical intestinal obstruction using Gastrografin is a useful method because a correct decision can be made for or against surgery in doubtful cases. Gastrografin is a valuable diagnostic aid in cases with pseudo-obstruction since recurrent obstruction often seems to be a pseudo-obstruction. We doubt if a recurrent obstruction should be treated by any method of intestinopexy.

Adult↗
PubMed1978

[Further investigations of insufficient stretching-closing mechanism of the terminal esophagus (author's transl)].

The anatomy of the closing mechanism of the terminal esophagus was studied in the dogs since this animal is frequently utilized for investigations of esophageal function. With the aid of a special method we have demonstrated a stretching-closing mechanism similar to that of the human subject. An operatively placed hiatus hernia with a tendency to reflux shows the expected reaction of the muscular screw mechanism. This insufficient stretching-closing mechanism is similar to an insufficient "ring sphincter". The reconstruction of the closing mechanism by means of "stretching and gastropexie" which has proven successful in practice is discussed.

Animals↗
PubMed1978

[Functional morphology of the lower esophagus in reflux disease (author's transl)].

The function of the lower esophagus is discussed from a biomechanical point of view. The functional elements consist of the typical structure of the muscle fibers and of the construction of the opening to the stomach. In the active phase, the esophageal muscle fibers open the cardiac orifice, and during the resting stage, the normal longitudinal tension of the esophagus is responsible for closure. Biomechanical studies reveal the sliding hiatal hernia and reflux as momentary states in the pathomechanics of the lower esophagus. Hormonal regulation is unimportant. Based on biomechanical studies, a reasonable therapeutic approach is gastropexy.

Cardia↗
PubMed1977

[Disturbances of sexual function following rectal excision and sphincter preserving resections of the rectum (author's transl)].

Male sexual function represents a many-sided effect. The disturbances aredeveloped in variable degress. Impotency after excision of malignant tumours occurs in each second patient and after anterior resection is in a third of patients observed. A modest chance for recovery is possible. Careful anatomic dissection is of utmost importance to safe guard the sexual function following curative excision of cancer. This way is less likely to cause injury to the nerves in the critical areas.

Adult↗
PubMed1977

[Anorectal incontinence. Results of surgical treatment].

Anal incontinence was investigated in 125 patients. Sphincter suture war suitable for only 52. Opening the anal canal was avoided. Perineal female and male anatomy is very different. Reconstruction of continence by sphincter suture is only to be recommended after traumatic lesions.

Anal Canal↗
PubMed1977

[Results of esophago-intestinal anastomoses and studies of gastric, perfusion in the stomach mobilized for that purpose].

The results of 61 resections of the esophagus are reported. The cause of leakage is investigated. Using angiography and the TAS method, increasing diminution of the blood supply of the gastric wall can be observed after the ligature of 1, 2, or 3 arteries. Preservation of the right gastric artery and the right gastroepiploic artery, leaving an intact arcade, avoids necrosis of the suture line. However, it is better to remove the fundus in every case. Results after esophagointestinal anastomoses and investigations of blood flow in the mobilized stomach are reported.

Adolescent↗