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Biomedical subjects

G Kanzler

Publications and source records attributed to G Kanzler.

At least 19 recordsLinked to original sources
PubMed2004

Transabdominal ultrasonography in achalasia.

BACKGROUND: The aim of this study was to investigate whether transabdominal ultrasonography can differentiate between achalasia and neoplasms involving the oesophagogastric junction. METHODS: Ultrasonography was performed in 28 patients with achalasia, 28 sex- and age-matched controls and 13 patients with neoplasms. All studies were done with a 3.5 MHz real time curved array scanner and using an electronic caliper to measure oesophageal wall thickness and the maximum oesophageal diameter. Specificity and sensitivity in making a diagnosis of achalasia and tumours were determined by having unmarked images interpreted by a blinded observer. RESULTS: Patients with achalasia were identified by recognition of a dilated oesophagus without the presence of a neoplastic lesion (maximum oesophageal diameter (median)=achalasia: 20.0 (14; 25)mm; controls 10.1 (9; 11) mm; P < 0.001). Oesophageal wall thickness was similar in the two groups (achalasia: 3.2 (2.5; 3.4) mm; controls: 2.9 (2.5; 3.4)). In patients with neoplasms, a hypoechoic lesion was identified at the level of the gastric cardia. The sensitivity of making a tumour diagnosis was 100% and the specificity 82%. CONCLUSION: Transabdominal ultrasonography is a useful, non-invasive diagnostic aid in differentiating patients with primary achalasia from those with neoplastic lesions at the gastric cardia.

Abdomen↗
PubMed2002

Does scant hematochezia necessitate the performance of total colonoscopy?

BACKGROUND AND STUDY AIMS: Controversy exists as to whether all patients with lower intestinal bleeding need to undergo total colonoscopy. This study compares the prevalence of colonic neoplasms in patients reporting scant hematochezia with the prevalence in controls. PATIENTS AND METHODS: Structured interviews were carried out with 4265 consecutive patients referred for colonoscopy. Of these, 468 patients had scant hematochezia, 299 had occult rectal bleeding and 57 reported dark rectal bleeding. Patients with scant hematochezia were matched for age and sex with those having no risk factors for colorectal neoplasms. For all groups, we determined the prevalence of adenomas and cancers below and above 50 cm. RESULTS: Colonic neoplasms were found in 18 % of patients with scant hematochezia and in 7.5 % of controls. However, most of these tumors were located within the reach of a sigmoidoscope. Compared with controls, patients with scant hematochezia had no increased risk for proximal neoplasms (odds ratio [OR] = 1.2), while this risk was significantly increased in patients with occult rectal bleeding (OR = 3.1) and patients who had observed maroon-colored blood in their stool (OR = 4.8). CONCLUSIONS: Flexible sigmoidoscopy appears to be a sufficient work-up for young patients who have observed trace amounts of bright red blood on the surface of their stool.

Adenoma↗
PubMed2001

Life expectancy and cancer risk in patients with Barrett's esophagus: a prospective controlled investigation.

BACKGROUND: It has been suggested that patients with Barrett's esophagus have a substantially increased risk of esophageal and possibly extra-esophageal cancers. We compared the incidence of cancer and the survival rates of patients with Barrett's esophagus with those observed in patients with achalasia, with Schatzki's ring, and in the general population. PATIENTS AND METHODS: From 1980 through 1994, 60 consecutive patients with newly diagnosed long-segment Barrett's esophagus without dysplasia were seen in a single gastroenterology consultation office and followed until the Fall of 1999. Cancer incidence and survival rates were compared with age- and sex-matched patients with symptomatic Schatzki's ring (n = 60) and achalasia (n = 60). Survival data were also compared with those of the German population. RESULTS: During a mean (+/-SD) observation period of 10 +/- 5 years, 2 patients with Barrett's esophagus (3%; 95% confidence interval [CI]: 0% to 11%) developed esophageal cancer, and 9 (15%; 95% CI: 7% to 27%) developed extra-esophageal cancers. These data differed only slightly from those of patients with Schatzki's ring (esophageal cancer: n = 1, 2%; 95% CI: 0% to 9%; extra-esophageal cancers: n = 9, 15%; 95% CI: 7%-27%) and achalasia (no esophageal cancers, extra-esophageal cancers: n = 3, 5%; 95% CI: 1% to 4%). Estimated 10-year survival was similar in patients with Barrett's esophagus (83%), patients with symptomatic Schatzki's ring (80%), patients with achalasia (87%), and in the general population (82%). CONCLUSIONS: The cancer risk in patients with Barrett's esophagus has been overestimated. If patients with nondysplastic epithelium are followed, the risk of esophageal cancer is about 1 per 300 patient-years.

Adult↗
PubMed1999

Complications and adverse effects of colonoscopy with selective sedation.

BACKGROUND: Cardiopulmonary adverse effects are commonly observed in patients undergoing colonoscopy with sedation. This study determines the incidence of such events when sedation is given only when required. METHODS: In 2500 consecutive patients, colonoscopies were started without premedication but sedation was offered if significant discomfort occurred. Parameters of blood pressure, heart rate, oxygen saturation and patient appearance were continuously recorded by a nurse assistant. Additional adverse effects occurring during or after the procedure were noted in the patients' protocol. Risk factors for the development of complications were evaluated with the use of a logistic regression model and the odds ratio. RESULTS: Ninety-five percent of all patients required neither sedation nor analgesia. Adverse effects occurred in 59 patients (2. 4%). Twenty-six of these patients (1.0%) had short-lasting episodes of oxygen desaturation and 22 patients (0.9%) experienced vasovagal reactions. Mechanical complications occurred in a total of 8 patients (0.3%) and consisted of 2 perforations and 6 episodes of hemorrhage. In the logistic regression model, impaired physical status was the single most important risk factor for the development of cardiopulmonary complications (odds ratio 4.7; 95% confidence interval [2.0, 11.4]). CONCLUSIONS: In experienced hands, patients undergoing colonoscopy rarely require sedation. If selective sedation is used, cardiopulmonary adverse effects occur in approximately 2% of all patients, most of whom require no medical intervention.

Aged↗
PubMed1997

Complications and their impact after pneumatic dilation for achalasia: prospective long-term follow-up study.

BACKGROUND: With the exception of esophageal perforations, complications of pneumatic dilation are incompletely defined. This study analyzes the incidence of all complications of this procedure and their impact on the patients' clinical course. METHODS: Sixty-seven consecutive patients with achalasia underwent pneumatic dilation with a Browne-McHardy dilator. Patients were observed for 24 hours after treatment and evaluated 4 weeks later as well as at 2-year intervals for a mean follow-up period of 4.9 +/- 3.8 years. In patients with and without complications, the length of remission was evaluated by Kaplan-Meter life table analysis. RESULTS: Twelve patients (18%) developed morphologic complications consisting in one perforation, two intramural hematomas, and nine diverticula at the gastric cardia. Ten patients (15%) complained of prolonged postdilation chest pain. The 5-year remission rate in the latter patients was 51% compared to 42% for patients without complications and 11% for patients developing traumatic diverticula. Surgery was ultimately performed in one third of all patients, a rate that remained unaffected by the type of complication. CONCLUSIONS: Complications of pneumatic dilation are underestimated and underreported. More than 30% of all patients develop either prolonged pain or morphologic lesions. Although prolonged pain does not indicate an unfavorable prognosis, the appearance of diverticula may be associated with a shorter clinical remission.

Adolescent↗
PubMed1996

Anorectal function and morphology in patients with sporadic proctalgia fugax.

PURPOSE: The pathophysiology of sporadic proctalgia fugax remains unknown. This study investigates whether patients with this syndrome exhibit alterations in anal function and morphology. METHODS: Eighteen patients with sporadic proctalgia fugax and 18 sex-matched and age-matched healthy controls were studied. Manometric studies investigated anal resting and squeeze pressures, the rectoanal inhibitory reflex, rectal compliance, and smooth muscle response to edrophonium chloride administration. External and internal sphincter thickness was measured endosonographically. RESULTS: Patients had slightly higher (P = 0.0291) anal resting pressures (65.5 +/- 11.4 mmHg) than controls (56 +/- 9.9 mmHg). However, anal squeeze pressure, sphincter relaxation during rectal distention, and rectal compliance were similar in both groups, and no alterations were detected in external and internal anal sphincter thickness. Edrophonium chloride administration was followed by sharp postrelaxation contractions in two patients, whereas anal function remained unaltered in controls. Acute episodes of proctalgia, which occurred in two patients while under study, were associated with a rise in anal resting tone and an increase in slow wave amplitude. CONCLUSIONS: In the resting state, patients with proctalgia fugax have normal anorectal function and morphology. However, they may exhibit a motor abnormality of the anal smooth muscle during an acute attack.

Adult↗
PubMed1996

Treatment of proctalgia fugax with salbutamol inhalation.

OBJECTIVES: Although no generally effective treatment for proctalgia fugax is known, inhalation of salbutamol has been reported to shorten pain attacks in isolated cases. METHODS: We conducted a randomized, double-blind, placebo-controlled, crossover trial of inhaled salbutamol in 18 patients with proctalgia fugax. The clinical effect was evaluated by recording the duration of severe pain and discomfort during acute attacks. In addition, anorectal motility recordings were analyzed for possible changes in anal resting tone, sphincter relaxation during rectal distension and in rectal compliance prior to and following administration of the two test substances. RESULTS: Sixteen patients completed all investigations. Compared to placebo, salbutamol inhalation shortened the duration of severe pain (p = 0.019). The effect was most marked in patients having prolonged attacks. In the asymptomatic state, neither salbutamol nor placebo led to a significant change in anal resting pressure, anal relaxation during rectal distension, or rectal compliance. Salbutamol also did not alter the threshold for rectal sensation. CONCLUSIONS: Salbutamol inhalation shortens attacks of severe pain in patients with proctalgia fugax. The mechanism of this effect remains unexplained.

Administration, Inhalation↗
PubMed1994

Improved survival after colorectal cancer in patients complying with a postoperative endoscopic surveillance program.

This study investigates whether compliance with a postoperative surveillance program in patients with surgically treated colorectal cancer leads to prolongation of life. The clinical course of 212 patients who had undergone curative resections for colorectal cancer was monitored for at least five years. Eighty-eight patients adhered strictly to a rigid endoscopic surveillance program, and 124 did not. Tumor recurrences occurred in 10% of compliant and 14% of noncompliant patients. Patients with asymptomatic tumor recurrences survived significantly longer (p < 0.05; five-year actuarial survival: 42%) than those who were symptomatic (five-year actuarial survival: 8%). The overall survival rate was significantly higher (p < 0.0002) in compliant patients (five-year actuarial survival: 80%) than in noncompliant patients (five-year actuarial survival: 59%). Noncompliance increased the risk of early death by a factor of 2.5 (95% CI = 1.5; 4.2). It is concluded that postoperative endoscopic surveillance leads to early tumor detection, and is associated with an improvement in survival in patients with colorectal cancer.

Aged↗
PubMed1994

Disability and health care use in patients with Crohn's disease: a spouse control study.

OBJECTIVES: Studies reported from tertiary referral centers suggest that patients with Crohn's disease (CD) have a high rate of long-term disability. This study investigated whether this is true for less selected patient groups. METHODS: 106 outpatients who were diagnosed to have had CD between 1974 and 1985 were invited with their partners (n = 83) for a structured interview that addressed issues of lifestyle and quality of life. In addition, patient and insurance records were reviewed to compare the use of health care services and work disability of patients with CD with those of their partners. RESULTS: Twenty percent of patients and 8% of their partners believed that illness had affected their partnership, 17% versus 11% thought it had compromised their professional career, and 28% versus 10% believed it affected the overall quality of life. A significant impact of illness on these parameters (p < 0.001) occurred only if they were evaluated with the use of an analog scale. Differences between patients and their partners in the use of health care services and in work disability became insignificant after 6 yr of observation (p = 0.1415 and p = 0.4341). CONCLUSIONS: Most patients with CD and their partners experience a similar satisfaction with life. As time progresses, a decline in disability often can be observed.

Adult↗
PubMed1993

How reliable is digital examination for the evaluation of anal sphincter tone?

This study investigates whether digital examination of the anal canal can differentiate reliably between competent and incompetent sphincters. Digital examinations were performed by an experienced proctologist who was blinded with regard to the patient's history as well as manometric and endoscopic findings. There was poor correlation between manometric findings and digital assessment of anal sphincter tone. The sensitivity of digital examination for diagnosing incompetent sphincters ranged from 63% to 84%, whereas specificity was calculated as only 57%. It is concluded that even the experienced examiner needs to use more sophisticated methods than digital examination for the evaluation of anal sphincter competence.

Anal Canal↗
PubMed1992

Does endoscopic follow-up improve the outcome of patients with benign gastric ulcers and gastric cancer?

This study investigated whether an endoscopic surveillance program for patients with "benign" gastric ulcers and gastric cancer leads to early detection of neoplasms and improves survival. The clinical course of all patients diagnosed between 1977 and 1986 as having either gastric ulcers or gastric cancer was followed for a minimum of 3 years. Of 597 patients with initially benign gastric ulcers, 452 (76%) returned for the recommended endoscopic follow-up examinations. In eight patients (1.8%), repeated biopsies disclosed malignant neoplasms; four of these patients (0.9%) had become asymptomatic. Survival curves were nearly identical in patients who complied and those who did not. Of 241 patients with gastric cancer, 72 underwent partial gastric resection with curative intent and survived the first year. Resectable cancer was detected in 5 of 48 patients who complied (10%); none of these patients died of cancer. However, 5-year actuarial survival rates were similar between the patients who complied and those who did not. Although endoscopic surveillance may detect resectable cancer in selected patients, it remains to be shown that such a strategy improves survival.

Aged↗
PubMed1992

Single dilation of symptomatic Schatzki rings. A prospective evaluation of its effectiveness.

This study investigates the effect of a single dilation on the morphology of the lower esophageal ring and on the clinical course of symptomatic patients. Thirty-three patients were studied prospectively for a mean period of 24.3 +/- 19.2 months. Passage of a large bougie (46-58 F) resulted in a rupture of the ring in each instance and its mean diameter increased from 11.4 +/- 3.6 to 17.2 +/- 4.1 mm. No complications occurred, and all patients were symptom-free at the first follow-up examination four weeks after dilation. However, late symptomatic recurrences were frequent. After one year, the estimated proportion of patients remaining free of symptoms was 68% after two years 35%, and after five years 11%. Repeated treatments were performed with similar ease and effectiveness; again, no complications were encountered. Neither the initial ring size nor the presence or absence of esophagitis determined the likelihood of symptomatic recurrences. It is concluded that single dilations of symptomatic lower esophageal rings are safe, easily performed, and well tolerated. Long-term cure of episodic dysphagia is rare, but recurrences can be successfully treated by repeated dilations.

Adult↗
PubMed1991

[Pancreatitis associated with 5-aminosalicylic acid].

Acute pancreatitis with severe belt-like upper abdominal pain developed within 1-4 weeks of starting medication in three patients (29-year-old man with ulcerative colitis; 43-year-old woman and 22-year-old woman with Crohn's disease) treated, for the first time, with 5-aminosalicylic acid (mesalazine), 500 mg three times daily. Concentrations of lipase initially were 545, 1182 and 3000 U/l, and of amylase 243, 449 and 129 U/l, respectively. Symptoms receded within a few hours after the drug had been discontinued, enzyme levels returning to normal in the course of the next 2-3 weeks. On repeating the drug in two of the patients, in lower dosage, the pancreatitis recurred within a few days. These observations support the view that 5-aminosalicylic acid can cause acute pancreatitis, perhaps as an allergic reaction.

Acute Disease↗
PubMed1990

Clinical and morphological characteristics of early gastric cancer. A case-control study.

We investigated whether previously reported differences between the frequency and survival of patients with early gastric cancer in Europe and Japan represent a selection phenomenon or differences in tumor biology. Within a 10-year period, early gastric cancer was diagnosed in 51 outpatients and advanced gastric cancer in 190 patients, amounting to a 21.2% incidence of early gastric cancer. Patients with early gastric cancer had an age distribution and clinical presentation similar to those of patients with benign gastric ulcers (589) but markedly different from those in patients with advanced cancer. Histological types and tumor locations were comparable in patients with early and advanced gastric cancer, indicating a close relationship between the two neoplasms. Patients with early gastric cancer had markedly higher 5-yr survival rates (83.4%) than those with advanced gastric cancer (14.5%) and did not differ in this regard from patients with benign gastric ulcers (82.9%). None of the 51 patients with early gastric cancer died of disseminated cancer. If survival rates were estimated for matched pairs with comparable age, sex, and length of follow-up, these data remained essentially unchanged (early gastric cancer: 83.4%, 95% confidence interval 73.2%-93.4%; gastric ulcer: 87.8%, 95% confidence interval 74.7%-94.3%). We conclude that early gastric cancer in European patients is comparable to early gastric cancer in Japan with regard to its morphology, clinical presentation, and curability. Early investigation of patients with significant gastrointestinal symptoms may improve the prognoses of patients with gastric cancer.

Age Factors↗
PubMed1988

Follow-up of patients with colonic polyps containing severe atypia and invasive carcinoma. Compliance, recurrence, and survival.

Between January 1975 and December 1984 1769 polyps were endoscopically removed from 1219 patients. Eight percent of these patients had polyps containing severe atypia and 5.0% had polyps containing invasive cancer. A close postoperative surveillance program was followed by only a few patients, but compliance improved with longer follow-up intervals. Metachronous polyps were observed with similar frequency in patients with benign polyps (34.8%) and those with polyps containing severe atypia (23.8%) or cancer (41.7%). Patients in whom malignant polyps were endoscopically removed had a 5-year survival rate of 84.3% that did not differ from that of patients' whose polyps contained severe atypia (79.0%). It was concluded that endoscopic removal of malignant polyps with favorable histologic conditions does not impair survival. The follow-up program of these patients should be adapted to that of patients with benign polyps, a procedure that may even improve patient compliance.

Actuarial Analysis↗