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Biomedical subjects

G Lepsien

Publications and source records attributed to G Lepsien.

At least 55 records · Page 3Linked to original sources
PubMed1987

Surgical treatment of pancreatic pseudocysts.

Between 1966 and 1980, 54 patients (40 men and 14 women) with a mean age of 38 years were operated on for a pancreatic pseudocyst at the Department of General Surgery, University of Göttingen. The aetiology of the cysts was alcohol abuse in 35 patients, biliary diseases in 8, blunt abdominal trauma in 4, virus-induced in 2 and unknown in 5. With the exception of those who had had trauma, all patients were suffering from chronic pancreatitis. Surgical therapy included in all cases a cystojejunostomy (52 with a Roux-Y-limb and 2 with an omega loop). The mean follow-up period was 13 years (range 6 to 20 years). The late mortality was 15 per cent (8 of 52 patients). Recurrent cysts occurred in two patients (5 per cent) and relapse of pancreatitis in one third of the patients. Deterioration of carbohydrate metabolism was observed in 20 per cent of the patients. After drainage operation stool fat content became normal in 20 per cent and deteriorated in 13 per cent. Persistence or cessation of alcohol intake influenced the long-term results. From these data we conclude that both alcohol withdrawal and sufficient drainage of the pseudocyst are important factors in the prognosis of pseudocyst.

Adult↗
PubMed1987

[Barrett syndrome: clinical and practical consequences].

The Barrett-esophagus develops as a consequence of chronic reflux disease. Though the columnar epithelium is a self-protection against gastric fluid nearly all complications of reflux-disease are combined with an endobrachyesophagus. The different types of columnar-epithelium require careful primary diagnosis. The treatment of symptomatic patients consists in an adequate therapy of the reflux disease. Long-term endoscopic and histologic controls are necessary in every case of Barrett's syndrome.

Adenocarcinoma↗
PubMed1985

[Stelzner self-healing cecal fistula--course of healing and complications].

A retrospective study of 83 patients who underwent caecal fistula as described by Stelzner during the five-year period between 1979 to 1984 was carried out. 26 fistulas were performed after low anterior resection, 54 after anterior resection and 3 after left hemicolectomy. In 10.8% the operative closure of the fistula was necessary. An anastomotic insufficiency could be recognized clinically in 3.8%. The overall complication rate was 21.7%. The caecal fistula seems to be an effective procedure with a lower complication rate than the temporary colostomy.

Cecum↗
PubMed1985

[Subtotal thyroid resection in severe, iodine-induced hyperthyroidism].

Iodine-induced thyrotoxicosis due to iodine application in high amounts in patients with circumscript or disseminated thyroid autonomy, is complicated by a prolonged course, mainly due to a resistance to conservative therapy with thiourea derivates. We therefore decided to perform an early subtotal thyroidectomy in 24 thyrotoxic patients. This measure is in contrast to the common opinion that surgery should only be performed after normalization of thyroid hormones. In all 24 patients with severe hyperthyroidism, including three patients with thyroid storm, hormone levels decreased within a few days after surgery to normal or subnormal values and the clinical picture of thyrotoxicosis disappeared. In the case of thyroid storm the signs of disorientation normalized within 1-3 days. One patient died five weeks after surgery due to severe concomitant diseases. One patient exhibited transitory respiration distress and another had postoperative hypocalcemia. In 13 patients L-thyroxine replacement became necessary due to subclinical or clinical hypothyroidism. Surgery as a early treatment for thyrotoxicosis should be reserved for patients with severe illness where conservative treatment has been shown to be ineffective. In rare selected cases, when a rapid normalization is required, surgery without preoperative treatment seems to be justified. The effect of surgery was impressive in all our cases and there were only minor perioperative complications.

Adult↗
PubMed1982

[Gastro-oesophageal reflux--what if physiological? (author's transl)].

Gastro-oesophageal reflux was examined by taped long-term pH monitoring in 31 healthy subjects (16 men, 15 women; average age 28 years). The following was found: (1) reflux during the day is normal in health subjects, occurring predominantly after meals; (2) healthy persons have practically no reflux at night, after reaching the phase of deep sleep, the decisive difference between the healthy subject and those with reflux concerning the sleep phase, during which the patient with reflux has significantly increased reflux; (3) gastro-oesophageal reflux during the night is dependent upon depth of sleep, while position-dependent reflux was not observed.

Adult↗
PubMed1982

When is esophagitis healed? esophageal endoscopy, histology and function before and after cimetidine treatment.

In order to assess whether in reflux esophagitis morphological and functional disorders persist after macroscopic healing, cimetidine was given for 6-12 weeks at a dose of 1.6 g/day to 30 patients with acid gastroesophageal reflux and esophagitis. The mucosal defects healed in 6 patients, improved in 14 patients, and remained unchanged in 10 patients. Lower esophageal sphincter pressure, acid clearance, acid perfusion test, and histological signs of mucosal inflammation were assessed before and after treatment. The histological and functional findings did not improve after healing of the mucosal defects. Therefore, endoscopic normalization in patients with reflux esophagitis is not associated with the disappearance of inflammation and abnormal motor function. The persistence of these abnormalities might explain the tendency of esophagitis to recur after symptomatic and endoscopic "healing."

Adult↗
PubMed1982

Depression of mechanical and electrical activity in muscle strips of opossum stomach and esophagus by acidosis.

We studied the effect of acidosis on nerve-muscle preparations from the opossum stomach and esophagus. All muscle strips were mounted in superfusion chambers and spontaneous contractile activity was recorded from longitudinal and transverse gastric muscle strips. Mechanical activity in esophageal and oblique gastric muscle strips was elicited by electrical stimulation of intrinsic nerves. The contractile activity of all types of strips changed when the pH of the superfusate was lowered for 30 min from 7.4 to 7.0. The baseline tension rose in strips from the lower esophageal sphincter and in oblique gastric muscle strips, and a baseline tension occurred de novo in longitudinal esophageal strips. Muscle relaxation was also impaired in these three types of strips. The amplitude of contractions declined in transverse strips from the esophageal body and in transverse and longitudinal strips from the stomach. The frequency of spontaneous contractions and of the pacesetter potential as recorded by extracellular electrodes was also reduced by acidosis in muscle strips from the stomach. Similar but less marked changes occurred when the pH was lowered from 7.4 to 7.2 for 30 min. Most changes related to a pH of 7.0 became irreversible after superfusion periods of more than 2 h. These findings indicate that acidosis alters a variety of neuromuscular functions and that its effects are determined by the electrical and contractile characteristics and the intrinsic innervation of individual segments and layers of the gut muscle coat.

Acidosis↗
PubMed1981

A quantitative assessment of duodenogastric reflux in the dog after meals and under pharmacological stimulation.

Duodenogastric reflux was measured in the dog by a double marker technique which does not interfere with the gastroduodenal junction. Duodenogastric reflux occurred both with a lipid and a protein meal. The gastric accumulation of duodenal contents was higher with fat than with protein because fat slowed gastric emptying. It was even higher with atropine because in addition to slowing gastric emptying atropine also increased the reflux rate. The effect of atropine was offset by a histamine H1 agonist.

Animals↗
PubMed1981

[Surgical management of reflux disease].

Surgical therapy of reflux disease aspires to beneficially influence pathogenetic principles. Gastric-proximal vagotomy results in lowered aggressivity of reflux, the Roux-Y-procedure in elimination of bile reflux. Classical antireflux procedures, in particular valvuloplastic types, reduce or eliminate gastroesophageal reflux altogether. The procedure selected among these is to be based on the grade of reflux. Whereas in reflux of more benign character selection of procedures is among the less invasive types, reflux disease classified in stages III and IV requires selection of procedures with known and proven effectivity (valvuloplastic).

Animals↗
PubMed1980

[Therapeutic results of peptic stenosis in the esophagus (author's transl)].

Of 118 patients treated for peptic stenosis between 1970 and 1979, 89 cases (75.4%) had developed in connection with endobrachyesophagus, i. e., as the result of primary reflux disease; 26 cases were the consequence of secondary reflux disease without endobrachyesophagus. In three cases the peptic stenosis had to be explained as the result of a local acid secretion. The treatment which followed was conservative (bougienage + Cimetidine/Antacids) or operative (bougienage + fundoplication). The results of the therapy varied according to the type of stenosis. In cases where the stenosis was located in the upper part (endobrachyesophagus), good results could be achieved with conservative therapy in 38.3% and with operative therapy, in 67.3%. The results were worse in terminal stenosis (conservative therapy, 45.5%; operative therapy, 60%). Retrospective analysis of unsuccessful treatment shows that predominantly scarred stenosis shows worse results than florid stenosis with recent esophagitis.

Adult↗
PubMed1980

[Komarov-oesophagostomy and duodenocutaneous jejunal segment: a simple model for examination of the gastroduodenal region in the dog (author's transl)].

Direct and partially indirect methods to quantify gastro-duodenal motility in the dog require direct access to the stomach or duodenum without disturbance of the structures to be assessed. A procedure is presented, which combines Komarov-oesophagostomy and the process of duodenocutaneous jejunal segment. This procedure has proven to be simple and secure in technique and without problem in chronic experimentation.

Animals↗
PubMed1980

[Endoscopic-pneumatic dilation (EPD) for the treatment of achalasia (author's transl)].

The endoscopic pneumatic dilation (EPD) procedure introduces an instrument which can be used in combination with fiberoptic-endoscopes types GIF-P and GIF-P2. The dilator is characterized by simple, easy, and gentle handling, even with extreme deviation at the gastro-esophageal junction. In daily clinical routine it has been shown to be effective in the treatment of achalasia.

Dilatation↗
PubMed1979

[Treatment of reflux oesophagitis with cimetidine (author's transl)].

The effect of cimetidine on reflux oesophagitis was studied in a double-blind trial. Sixteen patients were given cimetidine 1.6 g/d, 20 patients received a placebo. Within the first six weeks the oesophagitis improved both on cimetidine and the placebo, but the patients taking the former had fewer complaints during the day than those on a placebo. Continuing the regimen for another six weeks further improved the endoscopic findings in patients with cimetidine but not in those on placebos. Complaints lessened during the sixth to twelfth week during cimetidine treatment, but remained unchanged under placebo administration. Complete healing of the oesophagitis was achieved in only 33% of patients with uncomplicated oesophagitis (grade I-III) and in 6% of those with severe complicated oesophagitis (grade IV). If non-surgical treatment is indicated, it must be continued through at least 6-12 weeks.

Adult↗
PubMed1979

[Cimetidine treatment of reflux esophagitis: results of a double-blind study].

The effect of cimetidine on healing of reflux esophagitis was investigated in a double blind study in which 16 patients received 1.6 g cimetidine/day and 20 patients placebo. After 6 weeks endoscopic healing or amelioration of the esophagitis was observed in 10 of 20 patients on placebo (50%) and in 9 of 16 patients receiving cimetidine (56%). Continuation of double blind therapy in 24 patients for another 6 weeks led to improved healing in 12 cimetidine patients but not in 10 placebo patients. In only 4 of 16 cimetidine patients there was complete healing of esophagitis at the end of the study. The cimetidine patients had fewer symptoms to a statistically significant degree after 6 and 12 weeks, respectively. It is concluded that, despite its statistically significant effects on esophagitis and reflux symptoms, cimetidine therapy of reflux disease is not satisfactory. If cimetidine therapy appears to be indicated, it should be continued for at least 12 weeks.

Adult↗
PubMed1979

[Cardia function after proximal-gastric vagotomy (author's transl)].

In 36 patients with chronic duodenal ulcer disease LES-function before and after proximal-gastric vagotomy was examined manometrically and by determining pH-values in a prospective study. In addition, esophagus biopsies were taken 5 cm proximal of the cardia. 12 healthy volunteers served as controls. A direct effect of proximal-gastric vagotomy on LES-function could not be shown. On the contrary, in 38,9% of the patients examined, preoperatively proven esophagitis disappears nearly completely 12 months following proximal gastric vagotomy. This positive effect of vagotomy is to be interpreted as a beneficial effect on regurgitated intestinal juice, more so than an effect on cardia function itself.

Adult↗
PubMed1979

[The effect of Ca++ on gastrin output and LESP before and after antrectomy (author's transl)].

Previous investigations show that calcium infusion stimulates gastrin output in healthy volunteers, whereas after antrectomy calcium does not cause any significant change of IRG levels. Both healthy volunteers and antrectomized patients (B II) show a continuous increase of LESP, reaching a maximum after 120 minutes. These results suggest a direct interaction of Ca++-ions and gastrointestinal smooth muscle cells.

Adult↗