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Biomedical subjects

H Feussner

Publications and source records attributed to H Feussner.

124 records · Page 7Linked to original sources
PubMed1986

[Esophageal function following sclerotherapy of esophageal varices].

Functional disorders of the esophagus were evaluated in 24 patients 4 +/- 2 months after sclerotherapy following the first hemorrhage. The mean volume of polidocanol required per patient was 181 +/- 111 ml. 9 patients complained of dysphagia and/or reflux symptoms; strictures were found in two cases; 4 patients had esophagitis. Manometrically the lower esophageal sphincter was completely insufficient in 14 patients; only 7 patients still had a competent cardia. The first group had received significantly more polidocanol than the latter. Tubular motility was disturbed by nonpropulsive (18%) and repetitive (7%) contractions. By longterm-pH-metry the percentage of oesophageal reflux was elevated in all patients.

Deglutition Disorders↗
PubMed1986

[Cholecystectomy in liver cirrhosis with portal hypertension--limited surgical indications and increased surgical risk?].

From January 1, 1982 to November 15, 1985 in 29 patients with liver cirrhosis a cholecystectomy was performed, 40% of them had portal hypertension. In-hospital mortality was 7%; main cause of death was acute and chronic liver failure. Postoperatively few liver function tests were reduced temporarily, but there was a normalization within two weeks. Cholecystectomy should not be left to be done as an emergency operation because of its high mortality rate in contrast to elective operation (50 in comparison to 5-10%).

Adult↗
PubMed1985

[Fiberoptic bronchoscopy in intensive care medicine--functional efficacy and methodological side effects].

A prospective study was performed to determine the side effects of fiberoptic bronchoscopy on cardiopulmonary function, the influence of bronchial lavage on cardiopulmonary function, and the functional efficacy of fiberoptic bronchoscopy in obstructive atelectasis due to retained secretions. In 17 patients endotracheal intubation was immediately followed by a significant (P less than 0.01) rise in arterial, pulmonary artery and pulmonary capillary wedge pressure, heart rate, and cardiac output. There were no statistically significant differences in arterial blood gases and intrapulmonary right-to-left shunt. Two patients showed circulatory changes indicative of a heart insufficiency on the left side. A significant increase (P less than 0.001) in intrapulmonary right-to-left shunt from 12% to 17.5%, a significant decline in arterial oxygen tension of 15 mm Hg, and a significant increase of cardiac output from 6.4 to 7.71/min following saline solution lavage (20 ml in each bronchus) were observed in nine patients. The results indicate that bronchial lavage is the essential mechanism for the decline in arterial oxygen tension induced by fiberoptic bronchoscopy. In patients with unstable cardiopulmonary status, the cardiovascular response during bronchoscopy may be hazardous and the bronchoscopist should be aware of the pathophysiologic side effects involved. Fifteen therapeutic bronchoscopies were performed in five critically ill patients with obstructive atelectasis, due to retained secretions. Following the procedure, Qs/Qt declined from 23.9% to 15%, cardiac output from 9.3 to 7.31/min, and arterial Po2 increased from 58.9 to 70.9 mm Hg. The differences were statistically significant (P less than 0.0001). The therapeutic value of fiberoptic bronchoscopy in the treatment of obstructive atelectasis is demonstrated by the significant improvement in cardiopulmonary status.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Endoscopic sclerosis and esophageal balloon tamponade in acute hemorrhage from esophagogastric varices: a prospective controlled randomized trial.

A prospective randomized controlled clinical trial was performed in 43 consecutive histologically proved cirrhotic patients with endoscopically proved actively bleeding esophageal varices. Twenty-two were randomly selected to have esophageal tamponade with the Sengstaken-Blakemore tube, and 21 were selected to have endoscopic sclerosis of the esophageal wall. The two groups were similar in demographic, clinical and laboratory data. Bleeding was controlled by the Sengstaken-Blakemore tube in 16 of 22 patients (73%) and by endoscopic sclerosis in 20 of 21 (95%). Among those controlled by the Sengstaken-Blakemore tube, seven (44%) rebled and three (43%) were again controlled by the Sengstaken-Blakemore tube; in the endoscopic sclerosis group, four (20%) rebled and three (75%) were controlled. Thus, hemorrhage was definitively controlled in 52% of patients and 66% of bleeding episodes in the Sengstaken-Blakemore tube group and in 90% of patients and 92% of bleeding episodes in the endoscopic sclerosis group. The definite control of hemorrhage was significantly better in the endoscopic sclerosis group (p less than 0.01). The Sengstaken-Blakemore tube patients received no definitive therapy after bleeding had been controlled. Within 30 days, six patients (27%) in the Sengstaken-Blakemore tube group had died compared to 2 (10%) in the endoscopic sclerosis group which is statistically significant (p less than 0.01) in favor of endoscopic sclerosis. The frequency of complications was similar in the two groups. Endoscopic sclerosis patients received serial endoscopic sclerosis after bleeding had been stopped during the whole period of follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMedDate not supplied

Preoperative staging of gastric cancer as precondition for multimodal treatment.

Preoperative staging of gastric cancer plays a crucial role every multimodal treatment protocol. At present, staging intends to be far more than evaluation of the depth of tumor infiltration into the organ wall, that is, T stage, nodular status (N category), and the presence of distant metastases (M stage) according to UICC criteria. In modern surgical oncology it includes more often the evaluation of prognostic factors such as the RAS-protein, p53 tumor suppressor gene, growth factor receptors, cell adhesion molecules, proteolytic factors, and proliferation-associated antigens. Furthermore, evaluation of nodular status is possible by sophisticated computer programs. The conventional staging of gastric cancer using endoscopy and sonography, conventional ultrasonography, computed tomography, and magnetic resonance imaging is discussed. Possible improvements of staging in oncologic centers should include surgical laparoscopy, laparoscopic ultrasonography, and meticulous evaluation of an abdominal lavage including immunohistochemical detection of free tumor cells. The most promising tumor biology-related prognostic factors in gastric cancer are briefly discussed.

Combined Modality Therapy↗
PubMedDate not supplied

Reoperation following failed fundoplication.

Fifty patients reoperated for failed Nissen fundoplication are presented; 29 patients (group 2) were operated between 1983 and 1988 while 21 patients (group 1) were operated before 1983. In group 1, the "slipped Nissen" had been the most frequent cause of reoperation (48%). In group 2, the most frequent causes for the unsuccessful operation were: (1) partial or total disruption of the fundic wrap (62%), (2) slipping of the fundoplication, giving rise to the telescope phenomenon (21%), and (3) creation of a fundoplication which was too low (10%). Refundoplication was performed in cases where the dissection of the previously formed fundic wrap was possible (42/50 = 84%). In group 1, three patients were treated by resection of the cardia, one by an Angelchik prosthesis and one by a distal gastric resection with Roux-en-Y diversion. In group 2, fundectomy was performed in one patient; in another, an Angelchik device was inserted, and in a third patient, fundoplication and proximal gastric vagotomy were performed. The results were excellent or good in 66% of patients in group 1 and in 76% of group 2. Operative mortality was 2% and morbidity, 4%. In conclusion, repeat fundoplication is recommended when reestablishment of the fundic region anatomy is possible during dissection. The operation can usually be performed through an abdominal route. Meticulous preoperative evaluation of the patients including 24-hour pH measurement and manometry is necessary. Good results of refundoplication should be expected in 66%-76% of patients with recurrent disease.

Adolescent↗
PubMedDate not supplied

Fundoplication: how to do it? Peri-esophageal wrapping as a therapeutic principal in gastro-esophageal reflux prevention.

The prerequisites for a successful outcome after fundoplication are careful patient selection, good technique, and an understanding of the principles of antireflux surgery. The most important aspect of any such operation is the construction of a peri-esophageal ring around the gastro-esophageal junction buttressing the sphincter and, thus, neutralizing the gastric opening pressure. Accordingly, the operation has to comprise: 1) generous dissection around the gastric fundus to allow the formation of a "floppy" fundoplication; 2) construction of the cuff as short as possible (2 cm to 3 cm); and 3) proper fixation of the cuff at the correct site in the region of the lower esophageal sphincter. Adherence to these principles will avoid postoperative dysphagia or functional gastro-intestinal disorders and produce long-lasting reflux control in approximately 90% of patients at 10 years. Problems of hypercontinence may occasionally occur since gastro-esophageal reflux suppression is usually complete and any physiological reflux abolished. With the advent of modern drug treatment, the excellent results achieved by fundoplication need to be maintained despite fewer operations. Careful postoperative quality control including pH monitoring is therefore mandatory. The principle of periesophageal wrapping is likely to remain the cornerstone of antireflux surgery. Current techniques are, however, likely to evolve. One direction being investigated is laparoscopic fundoplication, rendering the procedure much less invasive.

Esophagogastric Junction↗
PubMedDate not supplied

Minimally invasive antireflux procedures.

The advance of endoscopic and laparoscopic techniques in recent years has prompted several groups throughout the world to investigate the possibilities for a minimally invasive approach to reconstruct a defective antireflux mechanism in patients with intractable gastro-esophageal reflux disease. Prospective trials are needed to evaluate the long-term durability and efficiency of these procedures.

Esophagoscopy↗
PubMedDate not supplied

Clinical value of diagnostic laparoscopy with laparoscopic ultrasound in patients with cancer of the esophagus or cardia.

Accurate pretherapeutic tumor staging becomes increasingly important for the selection of therapy in patients with cancer of the upper gastrointestinal tract. We prospectively assessed the clinical value of diagnostic laparoscopy with laparoscopic ultrasound and peritoneal lavage in 127 consecutive patients with cancer of the esophagus or cardia but no evidence of hepatic metastases, peritoneal tumor dissemination, or other systemic tumor manifestations on standard staging techniques. There was no mortality or morbidity associated with diagnostic laparoscopy. Diagnostic laparoscopy with laparoscopic ultrasound showed relevant previously unknown findings, particularly in patients with locally advanced adenocarcinoma of the distal esophagus or cardia (hepatic metastases in 22% and peritoneal tumor spread or free tumor cells in the abdominal cavity in 25%), whereas the diagnostic gain was low in those with squamous cell esophageal cancer. The sensitivity and specificity of laparoscopic ultrasound in predicting positive celiac axis lymph nodes were 67% and 92%, respectively. These data indicate that diagnostic laparoscopy with laparoscopic ultrasound and peritoneal lavage is safe and frequently provides therapeutically relevant new information in patients with locally advanced adenocarcinoma of the distal esophagus or cardia, whereas the clinical value in patients with squamous cell esophageal cancer is limited.

Adenocarcinoma↗
PubMedDate not supplied

Bile reflux in benign and malignant Barrett's esophagus: effect of medical acid suppression and nissen fundoplication.

Bile reflux has been implicated in the pathogenesis and malignant degeneration of Barrett's esophagus, but clinical studies in patients with adenocarcinoma arising in Barrett's esophagus are lacking. Ambulatory esophageal measurement of acid and bile reflux was performed with the previously validated fiberoptic bilirubin monitoring system (Bilitec) combined with a pH probe in 20 asymptomatic volunteers, 19 patients with gastroesophageal reflux disease (GERD) but no mucosal injury, 45 patients with GERD and erosive esophagitis, 33 patients with GERD and Barrett's esophagus, and 14 patients with early adenocarcinoma arising in Barrett's esophagus. Repeat studies were done in 15 patients under medical acid suppression and 16 patients after laparoscopic Nissen fundoplication. The mean esophageal bile exposure time showed an exponential increase from GERD patients without esophagitis to those with erosive esophagitis and benign Barrett's esophagus and was highest in patients with early carcinoma in Barrett's esophagus (P <0.01). Pathologic esophageal bile exposure was documented in 18 (54.5%) of 33 patients with benign Barrett's esophagus and 11 (78.6%) of 14 patients with early adenocarcinoma in Barrett's esophagus. Nissen fundoplication but not medical acid suppression resulted in complete suppression of bile reflux. Bile reflux into the esophagus is particularly prevalent in patients with Barrett's esophagus and early cancer. Bile reflux into the esophagus can be completely suppressed by Nissen fundoplication but not medical acid suppression alone.

Adenocarcinoma↗
PubMedDate not supplied

Bile acids as components of the duodenogastric refluxate: detection, relationship to bilirubin, mechanism of injury, and clinical relevance.

Excessive reflux of bile into the stomach or esophagus has been associated with a variety of benign and malignant foregut disorders. The interaction of gastric acid with bile acids and the development of mucosal damage has been studied extensively in in vitro and in vivo animal models. These studies show that soluble bile acids can enter mucosal cells when in their non-ionized lipophilic form, accumulate there up to eight times the luminal concentration, and thus cause injuries to cell membranes and tight junctions. Entrance of mucosal cells and accumulation are pH-dependent and more pronounced at acidic pH ranges. The noxious effect of bile on intestinal mucosa is thus related not only to the concentration of luminal bile acids but also to the pH and the mucosal exposure time. Due to the lack of objective and accurate tests to quantitate reflux of bile acids in vivo over prolonged periods of time, the concept of bile reflux as a pathogenic factor in the clinical situation has been controversial. Recent studies indicate that intraluminal bilirubin can be used as a reliable marker of bile reflux into the stomach or esophagus. Combined 24-hour monitoring of intraluminal pH and bilirubin with the newly-developed Bilitec system, despite some system-inherent shortcomings, therefore has the potential to clarify the interactions between bile reflux, mucosal injury and gastroesophageal carcinogenesis.

Bile Acids and Salts↗
PubMedDate not supplied

Antireflux surgery: a current comparison of open and laparoscopic approaches.

The technologic advances of laparoscopic surgery have recently resulted in a renaissance of antireflux surgery as a minimal invasive alternative to life long medical treatment in patients with gastroesophageal reflux disease. The now vast experience has shown that, in experienced hands, laparoscopic antireflux surgery is feasible, shortens the hospital stay and recovery period, and provides a cosmetically more satisfying result than the open procedures. The rate of intra- and postoperative complications of laparoscopic antireflux procedures is, however, not significantly lower than that reported after open procedures. The laparoscopic approach is even associated with some additional sources for complications, i.e., trocar injuries, perforations of the esophagogastric junction, and herniation of the repair into the chest with a significant rate of early reoperations. Short term and intermediate results of laparoscopic antireflux procedures appear comparable to those obtained with the procedures performed via a laparotomy. Whether this is also true for the long term outcome will have to be shown by the follow-up of the large series of laparoscopic antireflux procedures that have been performed in the recent years. Before these data are available, one should be careful not to widen the indications for antireflux surgery just because the procedure can now be performed laparoscopically.

Gastroesophageal Reflux↗