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Biomedical subjects

F Stelzner

Publications and source records attributed to F Stelzner.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Anorectal fistulas].

Most anal fistulae appear to originate in a proctodaeal gland, the gland penetrates only a part of the spincter muscles. Therefore the fistulous track passes merely through a part of the spincters. The best treatment is to lay open the fistulous main track, this is sometimes difficult. The wound will heal and the scar will become part of the anal verge. The smallest part of preserved sphincter muscles saves the anorectal continence in most cases. Exteriorisation of the internal fistula opening by plastic procedures is not so safe but sometimes unavoidable, for example with perineal fistulae of women or in pelvirectal fistulae. These are always iatrogen.

Fecal Incontinence↗
PubMed1999

[Pathophysiology of chronic constipation and new therapy recommendation].

Three causes of constipation are known: Chagas' disease, congenital megacolon (Hirschsprung's disease) and continent obstipation. Those diseases are rare, they can be treated successfully by drugs, surgery or psychotherapy. More common is the idiopathic chronic constipation, observed manly in females. A frequent cause is the laxative abuse for many years. The possible etiologic factors are discussed. Based on the fact, that constipation never occurs in patients with a colostomy, reasons for the development of chronic idiopathic constipation are presumed in a disturbance in the distal colon and the anorectum. A possible explanation for the malfunction of defecation could be a different calibre between the usually tight pelvic colon and the wide rectum. In contrast to the apolar structure of the large bowel, the rectum shows a polar fibrous configuration. An additional disorder in the feedback mechanism between continence and defecation could impede the bowel passage. Because of these observations and thoughts, we performed a deep resection of the rectum in 18 patients instead of resecting the dilated and elongated colon. All patients operated that way experienced a major improvement of their bowel function. Postoperatively the bowel movements were regular and normal.

Adult↗
PubMed1997

[Itinerary through 125 years of German Surgical Congresses].

The German Society of Surgery was founded in 1872 with 127 members. Now there are more than 5000. The first congress was attended by 81 members. In those days, a lively discussion was possible. Meanwhile, many subspecialties have developed from general surgery, which articulate themselves in parallel sessions. For these reasons, a discussion in the plenary does not exist anymore. The conventions predominantly communicate results. No original innovations were recognized immediately. This is evident from examples. Today the industrial exhibition is an important factor for the progress which is linked to these congresses.

Congresses as Topic↗
PubMed1996

[Development and clinical anatomy of the rectal adventitia. significance for radical operation of rectal carcinoma].

The development, topography and clinical anatomy of the adventitia recti were studied in 300- to 600-microns-thick sections through the pelves of human fetuses and newborn children and 5-mm sections through the pelves of adults. The adventitia recti constitutes a continuous compartment bordered laterally by the fascia recti. In the adult the adventitia recti consists mainly of adipose tissue. The extent of the adventitia recti differs in different parts of the rectal wall. The branches of the vasa rectalia superiora and the visceral lymph nodes of the rectum are situated within the adventitia recti. Our findings suggest that it is necessary to remove the adipose tissue of the adventitia recti and the adjoining lymph nodes individually during resection of the rectum in order to minimize the risk of tumor recurrence.

Adipose Tissue↗
PubMed1996

[True and false local recurrence after continence resection for rectal carcinoma--the evaluation and the mesorectum].

Our experience with 32 cases of real local relapses is presented. As pseudo recurrences we define metachchronous and residual synchronous cancer left in the ampule by mistake. The frequency of recurrence, patient factors, tumors and operative technique are discussed. Examples of the development (e.g. caused by implanting metastases from transsected lymph vessels) are presented. The special situation of the pelvic colon cancer among local recurrences is discussed. We also discuss the fact that recurrences have so far been impossible to detect in this area and local relapses have a poor prognosis. Most recurrences develop within the first two postoperative years. Only recurrences at the anastomoses have a true chance of healing permanently, and this can only be achieved with another operative procedure. Out of 27 recurrences 50% were operated on, and two of these remained free of disease. We have to strive for R0 margins of resection. The mesorectum must not always be removed at the time of the primary operation.

Aged↗
PubMed1996

[Changes in the concept of aging and what it involves].

In contrast to other organisms, which have a completely variable determination of their life span, man has achieved a prolongation of his life span. Previously, the minority surviving to old age were honoured for a fulfilled life. Today society must cope with a large number of ill as well as active elderly individuals. Creativity among the elderly is as rare as it is among the younger population, but the link to very cost intensive inactivity in life and science is as unchangeable as in phylogenesis, and possibly even necessary. This leads necessarily to a reserve among the young towards the old: They are politely tolerated.

Activities of Daily Living↗
PubMed1995

[Severe impairment of peritoneal cavity muscles in intensive care patients (comparative anatomic studies of respiration)].

The vital function respiration is kept up by the modifiable basal activity of the thin muscles of the abdominal cavity. The diaphragm is an important part of the respiratory muscular system. The muscular system of the 'splanchnocranium' exhibits a normal spontaneous activity, which is mostly open in the laryngeal region and mostly closed in the anorectal continence organ. In animals missing an abdomen, e.g. turtles, we find that the complete abdominal muscle system is connected to the lungs functioning as respiratory muscles. The most powerful lungs that exist are found in birds. Their lungs, which are situated in a stiff thorax are only ventilated through the air compartments, mostly by the abdominal muscles. By this, the role of abdominal muscles for respiratory function is shown. We studied intensive care patients requiring ventilatory support and found that the electromyogram of the external abdominal oblique muscle can be impaired or extinguished. In some cases the cause is a polyneuropathy, which can be reversible. In consequence, positioning measures, as prone positioning are capable of preventing progressive deterioration of ventilation/perfusion relationship.

Abdominal Muscles↗
PubMed1995

[Results and conclusions from 328 radical operations of rectal carcinoma by one surgeon. Comparative anatomic studies with Brachydanio rerio and Latimeria chalumnae].

The continence preserving procedures, even with small margins, have better curative results than amputation of the rectum. Nevertheless marginal continent resections have to take a defective continence into account. In clinical practice this is tolerated. A reason for the reduction of continence is the loss of the corpus cavernosum recti. Comparative anatomical investigations in Brachydanio, a fish species that is transparent in its larva stage, lead to the conclusion, that the rectum remains an abdominal organ even though it is situated in the lesser pelvis. Thus it is strictly separated from the totally differently developed pelvic organ of the urogenital system. This is also proven by the separate anlages of the lymph nodes, lymph and blood vessels. Concerning the continence organ it is referred to the formal sex difference. The female closure mechanism is weaker and more primitive. We could follow this principle back to the Latimeria. For this reason, after deep continent resections, women always are more subject to incontinence, and have to wear nightly pads, at times. We have operated on 328 patients during 1-1-1978 to 2-22-1989. Their curative rates relate to these considerations.

Animals↗
PubMed1994

[Function of the abdominal wall and development and therapy of hernias (among others: the para-colostomy hernia)].

The peritoneal cavity has a fascial skeleton with musculature that is nearly always active, i.e. it has resting tone activity. During pneumoperitoneum this resting activity increases very markedly. The pelvic floor and its integrated sphincters also have a similar type of spontaneous activity depending on Onuf's nucleus in the spinal cord together with the somatic and autonomic nerves. Hernias such as umbilical hernias develop with disruption of a scar. While in a child the common inguinal hernia develops in an open vaginal processus, in an adult it develops as the result of a congenital muscular defect in the abdominal wall. A femoral hernia develops in a gap through the pressure of the resting activity of the abdominal wall. A paracolostomy hernia develops after an incision in the fascial skeleton and after pull-through of a very adipose sigma-mesosigma. It can often be treated it by pulling a slim colon segment through the innervated rectus muscle incision and closing the gap in the fascial skeleton with a running suture. Incisional or umbilical hernias can be successfully treated by suturing with a continuous nonabsorbable thread. The best therapy for inguinal hernias is suturing of the hyperplastic fascia transversalis and the reconstruction of the muscle sphincter mechanism. Bassini operated on very large hernias with hyperplastic fascia, thereby achieving excellent results. Fascial hyperplasia has been shown to follow the use of tissue expanders.

Abdominal Muscles↗
PubMed1994

[Etiology and therapy of rectal prolapse. Experiences with 308 cases 1956-1991].

The cause of a prolapse of the rectum is intrinsic to the organ itself. Neither paralysis of the pelvic floor sphincter complex nor a loosening of the suspending ligaments--which have never been demonstrated in situ--are causative. Determining for the development of a prolapse of the rectum is the break in calibre between the very tight pelvic colon and the wide rectal reservoir. Radiologically we can prove that it is here, where the genesis of prolapse development starts. In comparative anatomy the rectal ampulla is equivalent to the cloaca. Its stable transverse folds (rugae) are reminiscent to the transverse folds of a cloaca anlage, e.g. in the crocodile. A rectal prolapse only includes this cloaca equivalent. For this reason it is never larger than about the size of a fist. Rectosigmoid resection, by removing the calibre break, removes the cause. The involved sigmoid resection also improves the symptoms of constipation. 107 cases operated by peripheral procedures had a recurrence rate of 23.3%, whereas 202 operations removing the calibre break had recurrences in only 3.8% of the cases. Here the calibre break resection has had the best permanent results with a follow-up period up to 30 years.

Adult↗
PubMed1993

[Acquired disorders of peritoneal cavity muscles. Abdominal wall denervation in pregnancy, denervation incontinence, and continent and incontinent constipation].

The peritoneal cavity has a fascial skeleton that is kept under tension by permanent variable resting tone maintained by the abdominal muscles. The lateral abdominal muscles, the diaphragm and the pelvic floor are all components of this fasciomuscular support system. Voluntary and reflective changes in muscle tension allow the entry and exit of matter into and out of the spherical abdominal cavity by opening and closing of specialized wall segments called sphincters. We have previously demonstrated the existence of a resting tone in the tail muscles of mammals from which the human pelvic floor muscles are derived. The pelvic floor and its integrated sphincters form the anorectal organ of continence. This organ is much weaker in females than in males. The spinal centers that govern continence, contain in the female significantly fewer ganglion cells than the corresponding centers in the male. Childbirth and a commonly found tendency to develop constipation are additional stressors for the congenitally weaker female organ of continence. We explain in this paper why the abdominal wall and the pelvic floor may suffer stretch-induced denervation injuries during pregnancy and delivery. Such damage may persist in later life and can give rise to incontinence and "flabby abdomen". Based on our work in this field, we found a new differentiation between continent and incontinent constipation. Continent constipation is caused by spasticity of the pelvic floor characterized by abnormally high sphincter activity. This spastic pelvic floor syndrome can be treated successfully by psychotherapeutic techniques. Incontinent constipation, in contrast, is always associated with subnormal activity of the sphincters and may be a cause of rectal prolapse. It can be treated successfully by anterior rectosigmoid resection. Incontinent constipation will also require operative approximation of the levators in many cases. Improvement cannot be expected to result from this procedure, however, unless the pelvic floor shows some residual resting activity.

Abdominal Muscles↗
PubMed1993

[Bowel preparation for surgery of the anus, rectum and colon].

Successful bowel preparation for proctologic surgery is not schematic possible for all patients. Quality of cleansing after whole gut irrigation in women for example with chronic constipation is not always as efficient as in other patients. Two techniques for preparation of the colon were compared in a controlled trial. Fifty given the strong laxative Prepacol and fifty with whole gut irrigation. Significantly more patients suffered from vomiting and postoperative infections (translocation?) following irrigation. Prepacol preparation was well tolerated, showed a similar quality of cleansing and only a small discomfort.

Anus Diseases↗
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↗