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Biomedical subjects

H Feussner

Publications and source records attributed to H Feussner.

At least 55 records · Page 3Linked to original sources
PubMed1999

Laparoscopic procedures.

Laparoscopic procedures are increasingly used in clinical surgery because of significantly faster convalescence than occurs with open surgery. These advances have been facilitated not least by modern gastroenterological procedures and the co-operation between surgeons and gastroenterologists. Laparoscopic cholecystectomy is the most evident example of such surgery. The widespread use of this minimally invasive approach was essentially made possible by the availability of endoscopic retrograde cholangiography (ERC) and ERT, since the laparoscopic removal of bile duct stones is still difficult and not always reliable. Further instances of so-called 'therapeutic splitting' are palliative procedures and the combined endoscopic/endoluminal and laparoscopic/intracavitary approach in cases of early cancer. Additionally, laparoscopic procedures are described that might be a surgical alternative to medical treatment (e.g. fundoplication and cardiomyotomy).

Digestive System Neoplasms↗
PubMed1999

Pretherapeutic laparoscopic staging in advanced gastric carcinoma.

BACKGROUND AND STUDY AIMS: Direct visualization of the abdominal cavity by laparoscopy prior to multimodal treatment may be capable of improving the diagnostic precision of gastric cancer staging. The aim of this study was to evaluate whether diagnostic laparoscopy can influence treatment strategies in gastric cancer staged T3 and T4 by preoperative diagnostic tests. PATIENTS AND METHODS: Extended diagnostic laparoscopy (EDL) was carried out in 111 patients with advanced gastric cancer staged T3 or T4 by computed tomography (CT) and endoluminal ultrasound (EUS). On Lauren's classification of gastric cancer, 46% of the lesions were of the intestinal type and 54% of the nonintestinal type. EDL was carried out with the patients under general anesthesia, and included visual inspection of the abdomen, with surgical exploration of initially inaccessible regions, laparoscopic ultrasound examination, peritoneal lavage, and biopsies. The information provided by laparoscopy was classified as 1) no additional information, 2) important additional findings independent of the tumor stage, 3) downgrading of the tumor to a more favorable stage, and 4) upgrading of the tumor to a less favorable stage. The results of EDL were then compared with those obtained by sonography, CT and EUS in combination. RESULTS: EDL was performed successfully in 107 patients. In 56 of the 111 patients (50.5%), no additional findings were obtained. In 5.4% of cases, additional unforeseen information was found, not connected with the tumor but altering the management. EDL altered the preoperative diagnosis in 51 of the 111 patients (46.0%), leading to changes in management in 45 of them (40.5%). EUS provided additional information in eight cases (7.2% of the whole group, or 15.7% of those in whom the diagnosis had to be changed). Four metastases were detected using EDL. It was possible to rule out peritoneal spread in four patients, but it was newly detected in 26. CONCLUSIONS: Additional information by EDL about the tumor stage in gastric cancer led to a modification of the therapeutic strategy in 40% of patients, in spite of earlier comprehensive diagnostic work-up using modern imaging procedures. EDL should therefore be mandatory if neoadjuvant treatment is planned, in order to avoid either undertreatment or overtreatment of this type of tumor.

Adult↗
PubMed1998

[Indications for antireflux surgery of the esophagus].

In the Western world gastroesophageal reflux disease constitutes the single most common benign disorder of the upper gastrointestinal tract. Current medical therapy with proton pump inhibitors allows physicians to provide complete symptom relief and healing of acute esophageal mucosal injury in practically all affected patients. However, up to 50% of patients require maintenance therapy to prevent relapse. In these patients laparoscopic antireflux surgery offers an attractive and cost-effective alternative to potentially life-long medical therapy. Consequently, every patient with persistent or recurrent symptoms and/or complications of gastroesophageal reflux who depends on maintenance medical therapy to remain in remission is a potential candidate for laparoscopic antireflux surgery, particularly if of young age, suffering from side effects of medical therapy or worrying about long-term safety of the conservative treatment alternatives. A careful selection of patients, objective documentation of gastroesophageal reflux disease by 24-h esophageal pH monitoring, and meticulous attention to the technical details of the procedure are essential for a successful outcome of antireflux surgery.

Anti-Ulcer Agents↗
PubMed1998

[Teleconsultation].

Teleconsultation is a consultation between two or more physicians about the diagnostic work-up and therapeutic strategy in the treatment of an individual case by means of modern telematics. Due to more complex therapeutic strategies and legally defined formal requirements, the need for teleconsultation will increase significantly in the future. Rapid technical improvements in telematics will progressively facilitate the practical performance of teleconsultation (based upon an ISDN network in the beginning, later on by the use of a national health network). The medicolegal aspects of teleconsultation have already been defined sufficiently for use in surgery. However, the question of adequate financial compensation for this type of medical service is still unclear.

Computer Communication Networks↗
PubMed1998

Normal T lymphocyte and monocyte function after minimally invasive surgery.

BACKGROUND: The aim of this study was to evaluate immune defense mechanisms after laparoscopic (LCHE) and open cholecystectomy (CHE), particularly with regard to monocyte and T-lymphocyte function. METHODS: In a prospective study, we evaluated the following immunological data from 27 patients (21 women, six men; mean age, 47.2 years) submitted to elective LCHE and 14 patients (seven women, seven men; mean age, 60.8 years) undergoing elective CHE: T-lymphocyte proliferation (stimulated by SEA, SEB, TSST-1 with antigen presentation by patient monocytes), expression of cell surface molecules on monocytes (HLA-DR, CD80, L-Selectin), CD4+ T lymphocytes (HLA-DR, CD25, ICAM-1, L-Selectin), and granulocytes (L-Selectin). Blood samples were collected preoperatively and on postoperative days 1 and 6-7. Statistical analysis was performed using the Mann-Whitney U test for paired samples. RESULTS: HLA-DR on monocytes significantly decreased after LCHE during the early postoperative course but returned to preoperative levels within 1 week. After CHE, significant downregulation of HLA-DR expression persisted throughout the whole observation period. This decrease, however, did not alter the antigen-presenting capacity of monocytes in both groups. Moreover, the APC-independent proliferative capacity of T lymphocytes was unimpaired. CD25 expression was significantly increased on postoperative day 1 after CHE but not after LCHE. Expression of HLA-DR, ICAM1, and L-Selection on CD4+ T cells was not altered in either group. CD80 on monocytes and L-Selection on monocytes and granulocytes remained unchanged after both procedures. CONCLUSIONS: HLA-DR surface molecules on monocytes that are required for antigen presentation were significantly decreased in both groups; they returned to normal within 1 week after LCHE but not after CHE. However, the antigen-presenting capacity for monocytes remained normal in both groups. T-cell stimulation, reflected by an increase of CD25 expression, was observed only after CHE, not after LCHE. We therefore conclude that LCHE interferes less with immune defense than CHE; however, the clinical relevance of the changes noted after the open operation remains to be determined.

Adult↗
PubMed1998

Referral patterns and motivation for anti-reflux surgery of patients suffering from gastroesophageal reflux disease.

Due to a better understanding of the pathophysiology of gastroesophageal reflux disease (GERD), as well as the improvements in surgical technique, the number of anti-reflux procedures has increased world-wide during the last decade. This trend has been facilitated by the advent of minimally invasive surgery. Although a great number of publications deal with the indications or selection of patients for surgery, only a few discuss the motivation of patients for choosing surgery rather than long-term medical treatment. In order to evaluate the different elements of motivation of patients suffering from primary gastroesophageal reflux disease, the data of 115 patients who had undergone anti-reflux surgery between January 1990 and June 1997 at the Department of Surgery, Technical University, Munich, were evaluated. As laparoscopic anti-reflux surgery has only been regularly performed since 1994 in our Department, the study period was divided and the two periods (1990-1993 and 1994-1997) were analyzed separately. The data were evaluated according to the referral pattern and the motivation of patients with GERD who chose surgery. In the period from 1990 to 1993, 38.5% of the patients were referred to surgery by general practitioners, 38.5% by internists, 10% by practicing surgeons and 8% by gastroenterologists. In 5% of the cases the patients themselves initiated surgery. The corresponding results for the period from 1994 to 1997 were 29%, 38%, 12%, 8% and 13%, respectively. The most common reason for a patient to choose surgery was moderate or only short-term response to appropriate conservative treatment, which accounted for 98% and 92% of the patients, respectively, during the study periods. This was followed by avoidance of life-long medical therapy and its potential risks in 77% and 85% of the patients. Fear of cancer was reported in 10% and 25%, respectively. In the second period, the option of a minimally invasive procedure was reported as an important factor in 45% of the patients. Although the number of anti-reflux procedures performed per year is increasing and there is also an increasing tendency regarding the application of minimally invasive procedures, the factors leading to referral failed to show significant differences in the two periods. The motivation of patients, however, clearly changed in favour of surgical therapy, mainly because of the availability of a minimally invasive approach.

Adolescent↗
PubMed1998

[New approaches in surgery--visceral surgery in the tension field between trauma from surgical access and radicality].

The introduction of laparoscopic surgery (LS) and the circumstances under which LS could improve the prognosis of patients suffering from malignant diseases has made the development of abdominal surgery very important during the last decade. It also has heightened our awareness of operative trauma, which is not just relevant for cosmetic reasons, the consumption of pain killers, or the stay in hospital. It also seriously affects the immune system of the patient and, in itself, operative trauma can be determined to the patient's disease. A minimalization of operative trauma is one surgical goal, especially in oncologic patients, but a limitation of the surgical access leads to oncologic risks which arise from the subsequent "handling" of the tumor. The high risk of released tumor cells has already been proven by the evidence of tumor cells in the peritoneal lavage and the detection of so-called port-site metastasis. For oncologic surgery reducing the trauma caused by the tumor is more important than reducing the trauma caused by the surgical access.

Abdominal Neoplasms↗
PubMed1998

[Achalasia and carcinoma of the esophagus: incidence, prevalence and prognosis].

Although the prevalence of patients with achalasia developing an esophageal carcinoma is low the risk is nearly 140-fold; there is no difference in prognosis between patients with achalasia-carcinoma and those with esophageal cancer without achalasia. We propose a follow-up with biennial endoscopies after 15-20 years of known achalasia. This is accordance with a recent consensus conference, which accepted the recommendation of the American Society of Gastrointestinal Endoscopy [3]. In doubtful findings we recommend brush cytologies and/or biopsies, especially if there should be a recurrence of "old symptoms" or the appearance of "new difficulties" which suggest the possibility of a malignant growth.

Adolescent↗
PubMed1997

Radical transhiatal esophagectomy with two-field lymphadenectomy and endodissection for distal esophageal adenocarcinoma.

Distal adenocarcinoma of the esophagus is defined as a tumor originating from an endobrachyesophagus or a tumor with its main tumor mass (more than two-thirds) located in the distal tubular esophagus. Controversy exists about the optimal mode of surgical resection. Some favor transthoracic esophagectomy, whereas others prefer transhiatal (blunt) esophagectomy. A radical transhiatal esophagectomy (RTE) combined with two-field lymphadenectomy and mediastinoscopic dissection of the upper thoracic esophagus (endodissection) is described herein. We assessed the short- and long-term results of this technique and compared them to a historical group of patients undergoing conventional transhiatal esophagectomy (THE) for adenocarcinoma of the distal esophagus. Altogether 124 patients underwent transmediastinal esophagectomy because of adenocarcinoma of the distal esophagus in our department between January 1986 and May 1995. Thirteen of these patients were excluded from this analysis because of preoperative chemotherapy. The remaining 109 patients were divided into two groups: 62 patients who underwent THE between January 1986 and March 1991 (51 men, 11 women; mean age 65.3 years, range 31-83 years) and 47 patients who had RTE between April 1991 and May 1995 (44 men, 3 women; mean age 63.4 years, range 41-84 years). To compare the long-term results of RTE and THE, we used a matched-pairs analysis considering tumor stage and age. The hospital (30-day) mortality was marginally lower in the RTE group (4.3% versus 6.4%), resulting in an overall mortality of 5.5%. The rate of pulmonary complications was insignificantly lower in the RTE group [19.1% RTE versus 25.8% THE; not significant (NS), and the rate of postoperative cardiac abnormalities significantly decreased after RTE (2.6% RTE versus 19.3% THE; p < 0.05). The overall rate of R0 resections was 87.2% (82.2% RTE, 87.1% THE). Overall survival was similar within the two study groups. Complete tumor removal, T and N stages, and the lymph node ratio were identified as prognostic factors for long-term survival. Overall survival was better after RTE than after conventional THE in patients with involved lymph nodes. The mean number of resected lymph nodes per patient in the RTE group was 26.7. Positive lymph nodes were most common in the paracardial region and at the lesser curvature (72%/10.8% of all invaded abdominal nodes). In the mediastinum positive nodes were most common in the paraesophageal and paraaortal region (48%/27% of all mediastinal nodes). Patients with positive abdominal and mediastinal lymph nodes had a poor long-term prognosis. Distal adenocarcinoma of the esophagus can be safely resected by RTE with two-field lymphadenectomy and endodissection. This technique allows radical "enbloc" resection of the tumor-bearing distal third of the esophagus, which includes the primary area of lymph node metastasis of adenocarcinoma of the distal esophagus: the lower mediastinum and paracardial region. The analysis showed that RTE incurred fewer cardiac complications and a better overall survival in N1-positive patients when compared retrospectively to THE. Intraoperative mediastinoscopy allows controlled dissection of the upper mediastinum and biopsy of several mediastinal lymph nodes, with the advantage of providing additional staging information.

Adenocarcinoma↗
PubMed1997

[Staging laparoscopy].

The so-called extended diagnostic laparoscopy (EDL) facilitates the comprehensive exploration of the abdominal cavity, thus improving the precision of the pretherapeutic tumor staging in gastrointestinal malignancies. EDL comprises visual inspection with a specific preparation of all relevant sites, laparoscopic sonography and retrieval of samples for biopsy and cytology. Additional relevant therapeutic information was obtained through EDL in 40.5% of gastric cancer patients. EDL could be of similar importance for diagnosing esophageal, hepatobiliary and pancreatic malignancies.

Biopsy↗
PubMed1997

Laparoscopic gastrojejunostomy and endoscopic biliary stent placement for palliation of incurable gastric outlet obstruction with cholestasis.

BACKGROUND: For patients with incurable malignant gastric outlet obstruction and cholestasis, laparoscopic gastrojejunostomy combined with endoscopic biliary stent placement seems to offer a minimally invasive palliation. METHODS: We retrospectively analyzed the data of 16 patients submitted to laparoscopic gastrojejunostomy. Laparoscopic gastroenterostomy was performed as an antecolic, side-to-side gastrojejunostomy with enteroenterostomy. In 12 patients cholestasis was relieved preoperatively by stent placement via endoscopy (n = 6, 37.5%), percutaneous access (n = 5, 31%) or bilioenteric anastomosis (n = 1, 6.25%). One patient needed a percutaneous Yamakawa prosthesis postoperatively. RESULTS: Mean operative time was 126 min. There were no intraoperative complications. In one patient conversion to open surgery became necessary because of extensive adhesions. The only postoperative complication was bleeding from a trocar site requiring reintervention; there was no mortality. Median postoperative hospital stay was 7 days. Delayed gastric emptying was observed in 3 (18.7%) patients. Median survival was 87 days after the operation. All patients died from their primary disease but could maintain oral intake during the remaining survival time. CONCLUSIONS: We conclude that laparoscopic gastrojejunostomy and endoscopic or percutaneous biliary stenting provide a good functional result while impairing the quality of life only to a minimal extent.

Adult↗
PubMed1997

Composition and concentration of bile acid reflux into the esophagus of patients with gastroesophageal reflux disease.

BACKGROUND: Reflux of duodenal contents into the esophagus of patients with gastroesophageal reflux disease has been suggested by pH and bilirubin monitoring but is rarely directly measured. A portable device has been developed and was used to collect and quantitate material refluxed into the esophagus under ambulatory conditions during a prolonged time period. The objective of this study was to use this device to quantitate the composition and concentration of bile acids refluxed into the esophagus of patients with gastroesophageal reflux disease. METHODS: Esophageal aspiration was performed on 43 normal subjects and 37 patients with reflux disease during a 17-hour period. Aspiration was performed through a modified 16F Salem sump tube, positioned 5 cm above the lower esophageal sphincter and connected to a portable, battery powered pump that aspirated continuously at 100 mm Hg pressure. Validation studies showed that minimal amounts of saliva and swallowed liquids were aspirated and that gastric pressure was not altered. Postprandial, upright, and supine collections were performed. Total bile acids were assayed by a standard enzymatic assay; specific conjugated bile acids were analyzed by high-performance liquid chromatography. RESULTS: There was no difference in the total aspiration volume between normal volunteers and patients with gastroesophageal reflux disease, although patients tended to have a higher volume in the supine and postprandial periods. Bile acids could be detected in 58% of normal subjects and 86% of patients (p < 0.003). The mean concentration of bile salt exposure (micromole per liter) was higher in patients during the postprandial and supine periods. The mean bile acid reflux rate (micromole per hour) during all three aspiration periods was significantly higher in patients. On a molar basis the composition of the bile acids was 60% glycocholic acid, 16% glycodeoxycholic acid, and 15% glycochenodeoxycholic acid. Taurocholic, taurodeoxycholic, taurochenodeoxycholic, and glycolithocholic acid constituted the remaining 10%. CONCLUSIONS: Patients with reflux disease have an increased concentration of bile acids in their esophageal aspirates. Most of the exposure occurs during the postprandial and supine periods. A variety of bile acids were detected, most of which were in their glycine conjugated form.

Adult↗
PubMed1997

Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. The European Study Group for Antireflux Surgery (ESGARS).

Laparoscopic surgery for gastroesophageal reflux disease has replaced the open approach in several institutions, and it is likely to become the "standard" for treatment in the near future. Members of five European surgical centers with extensive experience in pathophysiological research, diagnostic testing, and conventional surgery for esophageal disease met after five years of experience in using laparoscopic antireflux surgery, and established a plan to evaluate the potential for consensus among the centers involved in the surgical management of the disease. The consensus process started with a pathophysiological assessment of the reporting requirements for diagnostic workup. To allow a thorough appreciation of the surgical techniques used by all the participants, experience was exchanged in collaborative operations in an experimental surgical laboratory. It was concluded that the pathophysiological background to the disease is multifactorial, as many publications have shown in recent years. The group's meetings and discussions established a consensus list for the preoperative assessment of patients suspected of having gastroesophageal reflux disease, as well as a common list of operative techniques for successful antireflux surgery.

Europe↗
PubMed1997

Assessment of non-acid esophageal reflux: comparison between long-term reflux aspiration test and fiberoptic bilirubin monitoring.

Reflux esophagitis may result from the action of both acid and non-acid agents. The aim of this study was to test a new system able to measure the quantity of the bilirubin contained in the esophageal lumen. The analysis of esophageal reflux composition was conducted in two phases. In the first bile and pancreatic enzyme, concentration of 136 fluid samples obtained with ambulatory esophageal long-term reflux aspiration test were measured. For the second, the total bilirubin content of each sample was measured in vitro with a fiberoptic probe (Bilitec 2000, Synetics Medical Inc., Sweden). Studies were performed on 48 subjects: 43 patients with esophageal reflux and five healthy volunteers. The results of both techniques were then compared. Higher concentration of bile and pancreatic enzymes were found in esophageal fluid samples of patients with endoscopic esophagitis. Bile and pancreatic enzyme concentrations of esophageal fluid samples were higher in patients after gastrectomy compared to patients with intact stomachs. There was a significant correlation between the total bilirubin concentration of fluid specimens and the fiberoptic probe reading of bilirubin (r = 0.72, P < 0.001). The presence of bilirubin and bile acids within the esophageal refluxate can be determined reliably with continuous fiberoptic measurement. The correlation between total bilirubin content and the concentrations of pancreatic enzymes contained in the esophageal refluxate suggests that bilirubin is a good tracer for non-acid, duodenal or intestinal reflux in the esophagus.

Adolescent↗