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Biomedical subjects

G Feifel

Publications and source records attributed to G Feifel.

At least 73 records · Page 4Linked to original sources
PubMed1995

[Intersphincteric rectum resection with colosphincter pouch].

In rectal cancer the emphasis has moved towards sphincter saving resection. Tumor site and penetration depth decide the operative technique in low rectal cancer. 1) Resection at the upper confinement of the anal canal. 2) Intersphincteric resection at the level of the dentate line. Reconstruction is achieved by a colonic J-pouch. From 1991 to 1994 we operated on 35 patients with an average age of 58.1 years. An intersphincteric resection was performed in 11 patients whose tumor was situated between 0 and 2 cm upwards the dentate line. 24 cancers were situated between 2 and 6 cm of the dentate line and were resected at the upper confinement of the anal canal with a linear stapler. Tumor penetration depth was determined endosonographically (ES). Four patients had tumor stage ES T1, 13 ES T2 and 18 ES T3. A J-pouch of 7-9 cm size was sutured (11) or stapled (24) to the anal canal. In 10 patients who underwent intersphincteric resection the pre- and post-operative anal pressures were determined. We did not encounter major complications. In three patients a leakage at the colonal anastomosis postponed closure of the diverting colostomy. We had no anastomotic recurrence but one pelvic side recurrence. Four patients developed liver metastases; in one case resectable. Postoperative anal sphincter pressure was reduced in all cases but clinically relevant only in one. This patient has frequent major soiling, three patients have occasional minor leak. Two patients are incontinent of gas, 26 are perfect continent. One patient has bowel movements every two days, 15 one per day, 12 two per day and 3 three per day.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Ischemia of the extremity as a rare complication of alloplastic joint replacement].

Two cases of extremity ischemia after alloplastic knee and hip joint replacement are presented. In both cases early operative intervention led to complete recovery. The mechanisms of iatrogenic vascular injury following arthroplastic operations on the hip and knee joint are demonstrated. In particular, the importance of preexisting vascular occlusive disease is stressed. Diagnostic procedures and implications for treatment are discussed.

Aged↗
PubMed1995

[Bacterial clearance of the terminal ileum in relation to the ileocolic connection].

The ecology of the (neo-)terminal ileum was investigated in three groups of mongrel dogs (group 1 to 3; 6 animals per each group) depending on the ileocolic connection and the resection of the terminal ileum. The efficacy of a stabilized nipple-valve-anastomosis (SNVA) was evaluated comparing the physiological ileocecal valve and the conventional end-end-anastomosis. The relations of the aerobic and anaerobic bacterial counts of all 18 dogs (group 0) preoperatively served as reference-values. Under this physiological condition the median counts were found to be lower in the ileum than in the colon, two logs for the aerobic bacteria and three logs for the anaerobic bacteria, confirming statistical significance (p < or = 0.05). The resection of the terminal ileum conserving the ileocecal valve (group 1) had no influence on the bacterial flora of the neoterminal ileum, whereas the limited resection of the ileocecal valve with ileocolic end-end-anastomosis (group 2) induced a bacterial colonisation of the terminal ileum. In contrast, following wide ileocoecal resection and replacement of the ileocecal valve by the SNVA (group 3) the bacterial counts were lower in the terminal ileum than in the colon: five logs for aerobic and seven logs for anaerobic bacteria. This difference was statistically significant within this group between ileum and colon and between ileum preoperatively and postoperatively (p < or = 0.05). In conclusion, the bacterial clearance of the (neo-)terminal ileum depends more on the retrograde barrier-function of the ileocecal valve or an appropriate mechanical substitute than on the propulsive motility of the ileum.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Surgical↗
PubMed1995

[Endosonography of the esophagus and mediastinum].

It was only the endoscopic ultrasonography that allowed the esophagus and posterior mediastinum to be accessible to ultrasonography. The esophageal wall may be presented in its different anatomic layers to a degree of precision unattained by any other imaging procedure. Being important in the esophagus, both the upper rim of the tumor and the infiltration depth can this way be prognosed correctly to about 85%. In consequence, this allows proceedings appropriate to the tumor stage within the bounds of a multimodal therapeutic concept of esophagus carcinomas. Impressions of the esophagus caused by mediastinal tumors are safely distinguished from intramural tumors. Multiple biopsies to get an examination specimen from a deeper layer should be performed under no other conditions than after endoscopic ultrasonographic examination and just for special questions. In the differential diagnosis of achalasia and peptic stenosis of the esophagus, endoscopic ultrasonography proved to be less efficient. As for bronchial carcinomas, conclusive hints may be drawn from transesophageal and intratracheal ultrasonography. However, due to limited possibilities of judgment caused by air-containing structures these methods are not firmly established in the preoperative staging.

Carcinoma, Bronchogenic↗
PubMed1994

[An intestinal neosphincter attained by circumscribed muscle proliferation. Technical development and functional evaluation in the dog].

In an experimental study an intestinal neosphincter (INS) was constructed by modifying the principle of the ileocolic nipple-valve anastomosis by means of ultrasonic tissue fragmentation of the contacting serosa of the ileum and the corresponding mucosa of the ileum and colon. The healing of the muscle layers was studied histologically. The function of the INS was investigated in six dogs and compared intraindividually with that of the ileocecal valve and conventional end-to-end anastomosis. Morphologically the neospincters healed within 3 months without major fibrosis. The reference values of the aerobic and anaerobic bacterial counts in the terminal ileum were more than 2 logs lower than in the colon with the normal ileocecal valve, and after ileo-colonic end-to-end-anastomosis bacterial colonization of the terminal ileum was found both qualitatively and quantitatively. Subsequent interposition of the INS led to bacterial clearance of the terminal ileum. The median aerobic bacterial counts were lower by six logs and the an aerobic bacterial counts by 3 logs than in the colon. However, differences were not statistically significant owing to the wide variation in the individual values. Nevertheless, the demonstrable clearance of the terminal ileum could be explained by the orthograde passage with absolutely no stagnation and the relative competence of the INS in resisting retrograde pressure competence. In conclusion, ultrasonic fragmentation of the serosa and mucosa of the bowel allows construction of an INS from three muscle layers, which acts as a bacteriological barrier. Before it is introduced into the clinical setting its integration into the intestinal motility should be evaluated by further studies.

Anastomosis, Surgical↗
PubMed1994

Preoperative staging of rectal and colonic cancer.

In rectal cancer, endosonography assesses the tumor penetration depth, EUS T1 to EUS T3, with a sensitivity of 96% and a specificity of 89%. The evaluation of lymph nodes is less accurate, at 79%. The surgical strategy is different in the three parts of the rectum, and depends on the endosonographic tumor stage: upper third of the rectum--anterior resection for all tumor stages; middle third of the rectum--EUS T1 N0: transanal endoscopic microsurgery for "low-risk" carcinomas; EUS T1-2: anterior resection; EUS T3: anterior resection with complete excision of the mesorectum, reconstruction with coloanal pouch; lower third of the rectum--EUS T1 N0: transanal endoscopic microsurgery for "low-risk" carcinomas; EUS T1-2: anterior or intersphincteric resection with complete excision of the mesorectum, reconstruction with colon pouch; EUS T3: abdominoperineal excision. With the impact of endosonography, the proportion of abdominoperineal excisions has dropped from 46% to 15% during the last five years. Laparoscopic technology is likely to have an increasing impact on surgical procedures that have previously required an open approach. The following treatment policy derived from the endosonographic staging of colon tumors is proposed: EUS T1, laparoscopic segmental resection; EUS T2, laparoscopic oncological resection; EUS T3, conventional open surgery.

Colonic Neoplasms↗
PubMed1994

[Experiences with the Kock continent ileostomy].

First experiences with Kock-pouches (KP) in 34 patients operated on between 1987 and 1992 with stapler-stabilization of the nipple-valve are reported. 18 patients (52.9%) suffered from ulcerative colitis (CU), 7 patients (20.6%) from familiar adenomatous polyposis (FAP) and 9 patients (26.5%) from Crohn's colitis (CC). Each patient was inappropriate for ileo-anal pouch-procedure (IAP) and desired fecal control. Special indications for KP were identic with medical contraindications for IAP in 52.9%, refusal of IAP in 17.6% and loss of sphincter in 29.4%. In 25 patients with CU and FAP the rate of specific early complications was 24%. In 5 of 6 cases operative correction was successful. The rate of success was 96%, which could be maintained over time with a rate of 8.3% of late complications, that had to be corrected. In 9 patients with CC the rate of success was 77.8% due to two pouch resections in the early postoperative course. It decreased to 66.6% in the further course due to another resection later on. In CC, 3 out of 7 patients had repeated reoperations due to inflammatory complications of the disease not impairing pouch-function. A severe pouchitis was only observed in 2/18 patients with CU (11.1%). Thus, high rates of success in KP-surgery can be achieved for CU and FAP-patients. But it has to be kept in mind, that KP is not in concurrence with IAP, it is also an alternative to Brooke-ileostomy. Patients with CC are less appropriate, because the necessity for repeated reoperations due to recurrent disease reduces significantly the overall benefit of the patients, even if continence is preserved.

Adenomatous Polyposis Coli↗
PubMed1993

Rapid measurement of blood leakage during regional chemotherapy.

In order to avoid complications after regional chemotherapy (isolated hyperthermic perfusion) of the extremities, rapid measurement of blood leakage from the extracorporeal to the systemic circulation is important. A method using technetium-99m in vivo red blood cell (RBC) labelling is reported that provides results within 3 min. Blood samples drawn from the systemic and the extracorporeal circulation were measured for 99mTc activity using a mobile well counter, and the leakage values calculated. The mean result was 7.6% +/- 6.5%/15 min (n = 209). The corresponding flow rate was 100.2 +/- 85.7 ml/15 min (mean +/- SD). The values for isolation perfusion of the upper and the lower extremities are compared. The leakage results using 99mTc RBC labelling were correlated with other blood pool markers. Iodine-125 human serum albumin and indium-113 m transferrin were administered in subgroups of 4 and 19 patients simultaneously. Using linear regression, the coefficient of correlation was 0.72 for 99mTc/113mIn and 0.58 for 99mTc/125I. Comparison with the alternatives suggests that the rapid method of leakage measurement after 99mTc RBC labelling can be considered one of the most practicable and reliable methods available.

Chemotherapy, Cancer, Regional Perfusion↗
PubMed1993

Role of endosonography in the surgical management of non-Hodgkin's lymphoma of the stomach.

Ten patients with primary gastric non-Hodgkin's lymphoma (NHL) were preoperatively assessed by endoscopic ultrasonography (EUS). Tumor infiltration depth and lymph node involvement were assessed using the TNM classification system. EUS was 80% accurate in determining the TL stage and 90% in detecting lymph node metastases (NL stage). Based on the longitudinal tumor extent (antrum to fundus), as assessed by preoperative (n = 10) and additionally, intraoperative EUS (n = 3), partial gastric resection was performed in nine patients and total gastrectomy in one. All resection specimens had tumor-free resection margins (R0 resection rate 100%). These results were compared to those in 23 patients with gastric NHL operated on prior to the introduction of EUS in the hospital who were comparable with respect to tumor location and extent. In comparison with the ten cases where treatment was guided by EUS, the rate of total gastrectomy was higher (65% versus 10%) and the R0 resection rate lower (72% versus 100%) in this group of 23 patients. These results show that EUS may play a crucial role in the pre-surgical staging of gastric NHL.

Adult↗
PubMed1993

[Monstrous Buschke-Loewenstein tumor (condylomata acuminata gigantea) with transition to invasive squamous epithelial cancer].

The case of a 34-year-old female is reported, who has suffered from recurring condylomata acuminata of the anogenital region since she was 16. In the further course of the disease multiple Buschke-Loewenstein tumors developed, and finally an invasively growing, highly differentiated, keratinizing squamous cell carcinoma. The course of the disease was complicated by severe septicemia. In the framework of multimodal therapy, laser resection was the preferred method of surgical intervention. A systemic or local interferon treatment has only a prophylactic character in this stage of the disease.

Adult↗
PubMed1993

[Why do we need colon endosonography?].

Endosonography of the colon is a combination of coloscopy and sonography. Adenomas of the colon can be differentiated from carcinomas with the exception of focal carcinomas. This is a selection criterion for the laparoscopic segment resection of sessile adenomas. In the case of polyposis coli transformations into an infiltrating carcinoma can be seen. Colitis ulcerosa and colitis Crohn can be discriminated according to the different wall layer pattern, resulting in indications for the ileoanal pouch.

Colitis, Ulcerative↗