[The functional diseases of the esophagus].
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Adult↗
Biomedical subjects
F Stelzner
Publications and source records attributed to F Stelzner.
[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↗
[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↗
[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↗
[Early diagnosis of ileus].
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Administration, Oral↗
[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↗
[Failure in the treatment of carcinoma of the colon and rectum in connection with the operative technique (author's transl)].
Colonic and rectal anastomoses are more subject to leakage than anastomoses in other parts of the gastrointestinal tract. The mortality is high. Many aetiologic factors are connected with the operative technique. The great role of collagenase in the colon which increases during an infection is a cause for an anastomotic break-down.
Colon↗
[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↗
[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↗
[Cause and therapy of colonic diverticulosis].
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Aged↗
[Abnormality of the muscular structure of the colon: a possible cause of diverticulosis (author's transl)].
Diverticula of the colon result from myostatic contracture. In each case an asymmetric contracture leads to the formation of a gap in the wall of the bowel, through which the muscularis mucosae with the contents of the bowel slip out. Diverticulitis is compared with appendicitis.
Colon↗
[The development of diverticulosis and diverticulitis (author's transl)].
The cause of colonic diverticula is myostatic spasm. A low-residue diet contributes to this state as transit time through the bowel is slowed. Information gathered in 102 cases was analysed. The smooth muscle architecture of specially prepared operative specimens of diverticulosis were examined. In every case an asymmetric contracture of the smooth musculature led to the formation of gaps. Here the mucosa and muscularis mucosae can protrude through the bowel wall. The muscular spasm is responsible for incarceration of the diverticula. Inflammatory diverticulitis is compared to appendicitis.
Appendicitis↗
[Surgical treatment of colitis (author's transl)].
The main reason for poor results in treatment of ulcerative colitis may be found in the well-meant hesitation of the clinician to ask for surgical intervention. 233 cases are discussed, particularly the absolute and relative indications for surgery. For complicated cases of colitis, as well as for the so-called "colitic invalid" only operative treatment with an ileostomy offers optimal results. The high mortality of toxic megacolon as a consequence of the acute form of ulcerative colitis is discussed. The high post-operative mortality as a result of toxic mega-colon was significantly reduced by Turnbull's substitution of a multi-stage operation for the formerly used one-stage technique.
Colectomy↗
[Morphological and functional changes in the closing sphincter of the lower esophagus after experimentally-induced hiatal hernia].
Report of an experimental model of axial hiatal hernia in dogs, always combined with reflux (roentgenologic control). Using a new method of pressure measurement, the authors succeeded in proving the distention of the esophageal "sphincter". Morphologic investigations demonstrated, that in hernia the muscle fiber is no longer an apolar helical fiber, but runs nearly horizontally. The reduced susceptibility to pentagastrin is caused by diminished tension of the muscle fiber. The distal esophageal closing mechanism consequently seems to be a function of the whole organ and not of a hormonally regulated sphincter.
Animals↗
[Manometry, effect of pentagastrin and appearance of reflux in experimentally created hiatal hernia (author's transl)].
The importance of morphological and hormonal factors in the gastro-oesophageal junction can be evaluated, since a hiatal hernia comparable to the axial sliding hernia could be created in animal experiments. A new adequate procedure of manometry enables intraluminal pressures to be measured as a functional analysis. In 10 dogs a hiatal hernia with roentgenological reflux was performed. Pentagastrin administered intravenously could not prevent the gastro-oesophageal reflux. Pentagastrin intensified the muscle tension for only 5 minutes, but could not maintain the closing mechanism because of the altered morphological structure. After having restored the longitudinal tension of the organ by gastropexia, the terminal oesophagus has regained its closing function.
Animals↗
The morphological principles of anorectal continence.
Anal continence is depending on the rectum, the anal skin, the external anal sphincter and the levator ani as well as the corpus spongiosum of the rectum and the internal anal sphincter. Continuous contraction of a sphincter without fatigue can only be accomplished by smooth muscles. The internal anal sphincter in man does not contain any ganglion cells. It differs from the gastro-intestinal tract by not containing the so-called p-fibres. This electron microscopic difference between the internal anal sphincter and the rest of the gastrointestinal tract can also be demonstrated pharmacologically. Cholinergic and adrenergic fibres will both produce contraction of the internal sphincter. Comparative anatomical studies also show the uniqueness of this sphincter. For instance in the kangaroo the internal anal sphincter is the main sphincter of the anus. The sphincter system, like all other systems, is unable to regenerate and is therefore more than adequately provided for. For instance continence will be maintained even when the greatest part of the ring musculature has to be divided in patients with high ano-rectal fistulae.
Adolescent↗
[Surgical anatomy of the blood supply of the colon (author's transl)].
Studies in 12 cadavers about arterial supply of the appendices epiploicae. There are three kinds of appendices. All of them contain an arterial arch. This arch is derived either from the marginal artery or from the long vasa recta. The tying of appendices together with their vasa recta never interrupt the blood supply of the colon. There is always a sufficient collateral circulation. If however a marginal artery is tied the gut has to be transsected at the same level.
Adolescent↗