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Biomedical subjects

H Feussner

Publications and source records attributed to H Feussner.

At least 73 records · Page 4Linked to original sources
PubMed1997

Mechanical effect of the Angelchik prosthesis on the competency of the gastric cardia: pathophysiologic implications and surgical perspectives.

The Angelchik prosthesis appears to be effective in preventing gastroesophageal reflux, although its precise mechanism of action remains controversial. In a unique in vitro model, 10 freshly harvested canine esophagogastric specimens were tested for their ability to remain competent against challenges of intragastric pressure under controlled conditions of intra-abdominal pressure, longitudinal esophageal tension, lower esophageal sphincter pressure and overall length and circumference of the cardia (measure of gastric dilatation). Competency of the specimen was assessed by stepwise variation in the overall length of the sphincter, while keeping constant intraabdominal pressure (20 cm H2O), intragastric pressure (20 cm H2O), esophageal tension (physiologic), lower esophageal sphincter pressure (15 cm H2O) and degree of gastric dilatation (3 cm). With each specimen serving as its own control, the effect produced by the application of an Angelchik prosthesis was evaluated. Results consistently demonstrated that at any lower esophageal sphincter length the percent of competency was increased when the prosthesis was applied (P < 0.01). The findings indicate that the Angelchik prosthesis controls reflux by preventing unfolding of the lower esophageal sphincter when challenged by intragastric pressure.

Animals↗
PubMed1996

Failure of antireflux surgery: causes and management strategies.

BACKGROUND: With wider use of laparoscopic antireflux surgery, failed antireflux procedures are likely to become more common. METHODS: The causes of failure, management strategies, and outcome were analyzed in a consecutive series of 105 patients with failed antireflux procedures. RESULTS: Recurrent reflux was the most common primary symptom for referral (44.7%), followed by dysphagia (32.3%), and a combination of dysphagia and reflux (15.2%). The reasons for failure were disruption of the initial antireflux procedure (46%), a displaced repair (23%), a too-tight or too-long fundoplication (10%), an unrecognized motor disorder (9%), a paraesophageal or axial herniation (6%), or gastric denervation (6%). Revisional surgery was required in 71 patients, and 34 patients were managed conservatively. Intraoperative assessment during reoperation showed that technical errors during the initial procedure were responsible for failure in 40 of 71 patients. With an individual therapeutic approach, good results were achieved in 86% of patients undergoing revisional surgery. CONCLUSIONS: Technical factors and inappropriate patient selection are the most common reasons for failure of antireflux surgery. An individual therapeutic approach based on an exact analysis of the reasons for failure of the initial procedure is essential for the successful management of these patients.

Deglutition Disorders↗
PubMed1996

[Possibilities of telecommunications in surgery].

In contrast to telesurgery, telepresence involves only the audiovisual dialogue between the local surgeon and a remote expert; the latter, however, is able to actively monitor the operation by giving his judgement and recommendations. Under clinical conditions, telepresence may have the potential to facilitate intraoperative consultation of remote experts or even tele-assistance. Technical requirements consist of a suitable telemanipulation device (remotely controlled camera and indicator) and a high-duty communication system for real-time transmission of the operating site and the control signal. A minimum of 2 Mbyte/s of transmission capacity is recommended.

Computer Systems↗
PubMed1996

[Technical requirements and possibilities of teleconsultation in laparoscopic interventions].

Recent developments in robot technology and communication media have opened the way for their use in various medical techniques. Automated camera guidance as well as new telecommunication systems make it possible to carry out extensive laparoscopic operations precisely and to provide teaching assistance from great distances (so-called telepreceptorship). Long-term cost reduction, reduction of surgical complications and the improvement of quality standards are some of the benefits which could be realized by use of such systems.

Animals↗
PubMed1995

Preoperative chemotherapy for stage III-IV gastric carcinoma: feasibility, response and outcome after complete resection.

Despite extensive resection and systematic lymphadenectomy the prognosis of patients with locally advanced gastric carcinoma remains poor. The effect of preoperative outpatient chemotherapy with etoposide, doxorubicin and cisplatin was evaluated prospectively in 30 patients who had been shown by preoperative staging (including endosonography and surgical laparoscopy) to have gastric carcinoma stages IIIA, IIIB or IV. Haematological side-effects were common and necessitated hospitalization in 13 of 30 patients. Complete clinical response to neoadjuvant therapy was observed in eight of 27 evaluable patients. Resection was performed in 27 of 30 patients, with complete macroscopic and microscopic tumour removal in 24. There were no deaths and no major morbidity following operation. On multivariate analysis complete clinical response (P < 0.01) and complete tumour resection (P < 0.01) were the major independent predictors of long-term survival after neoadjuvant chemotherapy. Actuarial survival after complete tumour removal was superior with neoadjuvant therapy compared with results in an age-, sex- and tumour stage-matched control population who had primary resection (P = 0.07). Recurrence occurred in 17 of 23 evaluable patients who had complete tumour removal, with relapse in the tumour bed or area of lymphatic drainage in 11. These data show that neoadjuvant therapy in patients with locally advanced gastric carcinoma is feasible and appears to increase the rate of complete tumour removal. More powerful and less toxic regimens are, however, required to improve the response rate and to delay or avoid recurrence after neoadjuvant chemotherapy.

Adult↗
PubMed1995

Reoperations after failed antireflux procedures.

With the advent of laparoscopic surgery, the number of anti-reflux procedures performed has virtually exploded in some centers. Persistent, recurrent or new symptoms after an antireflux procedure are therefore likely to become a more common problem in the near future. Recurrent reflux is usually due to a breakdown of the repair and can frequently be treated medically or by a repeat antireflux procedure. In contrast, postoperative dysphagia, with or without accompanying reflux symptoms, may be due to a myriad of causes which include a slipped wrap, a wrap that has been placed around the stomach rather than the esophagus, a wrap which is either too tight or too long, the development of a stricture, the presence of a motor disorder of the esophageal body, or a combination of these factors. These situations can not usually be solved by a simple redo fundoplication or medications. Rather, the successful management of these patients requires an individual therapeutic approach, based on the presenting symptom or symptom constellation, the results of function tests and the intraoperative findings. The surgeon caring for patients with failed antireflux procedures should be intimately acquainted with the whole spectrum of revisional, resective and reconstructive procedures of the stomach, cardia, and esophagus.

Follow-Up Studies↗
PubMed1994

[The technique of laparoscopic ultrasound study in diagnostic laparoscopy].

In gastric cancer, retrogastric invasion or enlarged lymph nodes in the hilus of the spleen or at the celiac trunk can readily visualized with laparoscopic ultrasound examination (LUS). Invasion or metastases of the liver can be identified which are "invisible" with the "classic" imaging methods. In our series this led to revision of the TNM staging in 8% of 111 patients with advanced gastric carcinoma. In the staging of early pancreas cancer the standard methods of investigation, including ERCP, are unsatisfactory. Tumor localization, invasion of blood vessels and local or distal lymph node metastases cannot always be evaluated reliably. LUS promises to provide this valuable information. In carcinoma of the distal esophagus or the cardia, LUS can help to exclude small liver metastases, assess invasion of the diaphragm and evaluate the extent of enlarged intraabdominal lymph nodes, especially those at the celiac trunk. A frequent challenge/task for LUS is the exact determination of the benign or malignant nature of liver foci. Quite commonly they are inaccessible to percutaneous CT-guided puncture, but can be easily reached and biopsied under direct vision or LUS-guidance. By virtue of LUS and its information about extrahepatic lymph node infliction, diagnostic laparoscopy is now a less invasive but equally valid substitute for diagnostic laparotomy prior to liver transplantation in oncological diseases. LUS is now well established in diagnostic laparoscopy as a reliable tool for the preoperative staging of distal esophageal and abdominal tumors. It provides additional information which cannot be obtained with conventional imaging procedures.

Esophageal Neoplasms↗
PubMed1994

[Comparative study of the recovery phase. Laparoscopic cholecystectomy following isoflurane, methohexital and propofol anesthesia].

Total intravenous anaesthesia (TIVA) is increasingly used in short-stay surgery such as laparoscopic cholecystectomy. TIVA may provide fast recovery of psychomotor function, thus being of benefit to both the patient's behaviour and postoperative management. The purpose of this prospective study was to compare postoperative recovery from TIVA using propofol or methohexitone as the hypnotic component and balanced anaesthesia with isoflurane. PATIENTS AND METHODS. After giving informed consent and approval by the ethical committee of our hospital, 51 patients (ASA I, II) were investigated in a prospective study. Patients were randomised to receive either isoflurane, methohexitone, or propofol. Perioperative management with regard to premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia was carried out identically for all groups. Postoperative vigilance, pain, and nausea scores were assessed 15, 30, 60, 120, and 360 min after extubation with a visual analogue scale (VAS). At the same points, psychomotor recovery was investigated with the following assays: sedation as shown in Table 1; orientation with ten questions as to person, time, and location; memory as expressed by the patient's ability to repeat five words; a calculation test with five subtractions of the number 7 beginning from 100; and word generation by the number of words with an initial "m" given within 1 min and with animal names. Data were analysed with Kruskal Wallis' test for multiple comparisons between the groups and with Friedman's test for repeated measurements. All values are given as medians (interquartile range) or ranges. RESULTS. There was no difference between the groups' physical condition (Table 2). All intraoperative parameters compared well between groups; the management of anaesthesia was smoother with isoflurane than with the other anaesthetics. Psychomotor recovery was somewhat faster in the propofol group than the methohexitone group, as indicated by sedation score, orientation, memory and calculation tests (Table 4), word generation tests (Fig. 4), and subjective vigilance score (Fig. 3). The difference in recovery time between the propofol and isoflurane groups was minimal and without any significance or relevance. The incidence of postoperative nausea was significantly lower after balanced anaesthesia with isoflurane (24%, P < 0.05) as compared to TIVA with either propofol (53%) or methohexitone (41%). However, there were only minor differences between the groups; the ability to cooperate and be mobilised was not limited. DISCUSSION. Each of the three techniques used in this study is suitable for anaesthesia in patients undergoing laparoscopic cholecystectomy. Since fast recovery of vigilance and psychomotor function is very important in outpatient surgery, opioid-supplemented propofol anaesthesia is well established. Inhalation anaesthesia with isoflurane in air/oxygen without adding nitrous oxide compares well to propofol TIVA for laparoscopic surgery.

Adult↗
PubMed1994

Alkaline gastroesophageal reflux: assessment by ambulatory esophageal aspiration and pH monitoring.

The pathophysiologic effect of duodenal contents in the refluxed gastric juice of patients with gastroesophageal reflux disease (GERD) is controversial. We evaluated the composition of the refluxed gastric juice in 43 normal volunteers and 52 patients with GERD using a newly developed device that allows ambulatory esophageal aspiration. The findings were correlated with the results of 24-hour esophageal pH monitoring and the presence of complications of GERD. Compared with bile concentrations in normal volunteers, the total bile acid concentration in the reflux aspirates was higher in patients with GERD (p < 0.01). There was a significant correlation between the bile acid concentration in the aspirates and the percentage of time the pH was above 7 on ambulatory 24-hour esophageal pH monitoring (r = 0.59, p = 0.006), and both were highest during the night (p < 0.01). The bile acid concentration and the percentage of time pH was greater than 7 were particularly increased in patients with strictures or Barrett's esophagus (p < 0.01). Both an increased bile acid concentration in aspirates and the percentage of time with pH greater than 7 on pH monitoring were observed primarily in patients with a destroyed gastroduodenal barrier [status post Billroth II resection (BII), Billroth I resection (BI), or pyloroplasty] or after cholecystectomy. An increased bile acid concentration also occurred in a substantial number of patients without previous foregut surgery, although this did not usually result in an increase in the time that pH was above 7. These data suggest that contamination of the refluxed gastric juice with bile acids predisposes the patient to the development of strictures and Barrett's esophagus. An increased time that pH is greater than 7 on esophageal pH monitoring indicates biliary reflux and occurs primarily after previous foregut surgery. A normal-time pH above 7 does, however, not exclude contamination of the refluxed gastric juice with duodenal contents.

Bile Acids and Salts↗
PubMed1994

[Role of i.v. cholangiography and ultrasonography in preoperative diagnosis before laparoscopic cholecystectomy].

In a prospective clinical study the relevance of i.v. cholangiography and ultrasonography for preoperative diagnosis before laparoscopic cholecystectomy was assessed. Imaging of the common bile duct was realized successfully via i.v. cholangiography in 96.3% of all patients. Compared with ERCP, i.v. cholangiography diagnosis proved correct in 91.6% of all cases with pathological depiction of the common bile duct. Ultrasonography offered a sensitivity of 97.8% for assessing the common bile duct diameter. However, the distinction between intraductal concrements and artifacts caused by air superposition may be difficult. I.v. cholangiography is the most sensitive and easy to realize diagnostic technique to identify concrements in the common bile duct. The results of this study indicate that a combined strategy of i.v. cholangiography and ultrasonography may replace ERCP for preoperative diagnosis before laparoscopic cholecystectomy, if there is a sufficient depiction of the common bile duct and without concrements in it.

Adolescent↗