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Biomedical subjects

K E Grund

Publications and source records attributed to K E Grund.

At least 19 recordsLinked to original sources
PubMed1995

Therapeutic effect of argon plasma coagulation on small malignant gastrointestinal tumors.

In endoscopy, argon plasma coagulation (APC) is a new principle of non-contact electrocoagulation and has proved to be a sufficient tool for palliative endoscopic treatment of gastrointestinal neoplasms, predominantly of the oesophagus and colorectum. In a study of 67 patients suffering from histologically confirmed and endosonographic T1-staged tumours of the gastrointestinum, 10 patients were selected for endoscopic APC treatment because of the impossibility of surgical therapy. Although the application was primarily of a palliative nature, in 9 of 10 cases of minor neoplasms, no further tumour could be detected in biopsies during the observation period (9.45 +/- 2.8 months). One patient was not cured locally. In none of the patients was any serious complication noticed during the outpatient follow-up. The effective results and lack of severe complications suggest this technique as an alternative therapy in selected patients with smaller gastrointestinal tumours.

Aged↗
PubMed1995

[Highly flexible self-expanding metal mesh stents: a new kind of palliative therapy of malignant dysphagia].

Metal mesh stents are a new way in the treatment of malignant stenoses. Between 11/91 and 12/93 in 79 patients with malignant stenoses of the esophagus and the esophago-gastric junction 96 highly elastic, knitted, self-expanding nitinol stents (Ultraflex, Boston Scientific) were implanted. Most of the tumors being problematic, preoperated or preradiated, in 78 of 96 implantations endoscopic pretreatment (Laser, Argon Plasma Coagulation (APC), dilatation)--mostly in the same session--was necessary. Follow up time was 21 (2-108) weeks. In this pilot study 3.5 (1-27) controlendoscopies with 2.5 (1-10) endoscopic interventions were performed. 90 of 96 implantations were primarily successful and led to a functional success in 73 of 79 patients. The ability to swallow improved significantly, the score of dysphagia improved from 3.5 to 1.0 (p < 0.001). There were no relevant complications and no stent-related mortality. All stents could be kept patent during the follow up period using the new developed Argon-plasma-coagulation (APC) to treat the ingrowth of granulation tissue or tumor, which was observed during follow up in 72 of 93 implantations. Tumor ingrowth represents the main problem of the method and demands endoscopic posttreatment (APC) in cases with relevant re-obstruction. Impairment of the stent lumen by tumor ingrowth (granulation tissue plays no role) would have been observed in about 60% of the patients without such a treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Laser therapy for esophageal cancer. Results and additional endoscopic treatments.

Between 1/1/1988 and 5/31/1991, we treated 96 patients with laser therapy to the esophagus. In 61 inoperable patients, laser therapy has been performed initially. In 64% of these 61 patients, laser therapy alone gave sufficient relief of symptoms until death. However, in 36% of the patients, additional endoscopical interventions had to be performed. In 14 patients (23%), a prosthesis became necessary; 13 patients (21%) needed a percutaneous endoscopical gastrostomy. We conclude that laser therapy has an important role in the treatment of esophageal cancer, but in a significant number of patients, it might not be sufficient alone.

Adult↗
PubMed1990

[Meckel's diverticulum and lower gastrointestinal bleeding. Problems of preoperative diagnosis].

A hitherto perfectly healthy 28-year-old man suddenly passed stools containing bright red blood, and haemoglobin concentration fell at first to 10.1 g/dl. No bleeding source was found on gastroscopy and coloscopy. Nor was the source found by enteroclysis during a bleeding-free interval. Emergency laparotomy was performed after a recurrence of massive bleeding and revealed, 60 cm oral of the ileocaecal (Bauhin's) valve, a Meckel's diverticulum with ulcerated heterotopic gastric mucosa, 5 x 3 x 2 cm in size, and this was resected. 17 red blood cell concentrates had to be infused pre- and postoperatively, but there were no further complications.

Adult↗
PubMed1990

The consequences of tubulo-interstitial changes for renal function in glomerulopathies. A morphometric and cytological analysis.

Morphometric investigation of the structures of the cortex in kidneys exhibiting various types of glomerulopathy revealed the following: 1. In various types of glomerulonephritis, diabetic glomerulosclerosis, and glomerular amyloidosis there are significant correlations between the severity of fibrosis of the renal cortical interstitium and tubular atrophy resulting from chronic interstitial inflammation, and the serum creatinine concentration, creatinine clearance, inulin clearance and PAH clearance. 2. As illustrated with the example of membranoproliferative glomerulonephritis type I, if glomerulopathy alone is present, there is no elevation of the serum creatinine concentration, even if the glomerular inflammatory changes are severe; neither are severe renal amyloidosis that is confined to the glomeruli and severe isolated diabetic glomerulosclerosis associated with elevation of the serum creatinine concentration. 3. There is a significant negative correlation between the severity of interstitial fibrosis resulting from chronic inflammation and the total number and cross-sectional area of the intertubular capillaries; i.e., the total cross-sectional area and number of capillaries per unit area decrease as the fibrosis of the cortical interstitium increases. 4. Cases of glomerulonephritis in which there is accompanying fibrosis of the renal cortical interstitium have a significantly worse long-term prognosis than those in which there is only severe glomerulitis. 5. Obliteration of the post-glomerular capillaries leads to an increase in the cross-sectional area of the glomerular capillary convolution, the morphological equivalent of an increase in intraglomerular pressure. 6. The cause of the disease of the renal cortical interstitium that may accompany the various types of glomerulonephritis is not known. It is considered possible, as a working hypothesis, that this inflammation represents a T-cell stimulated autoimmune process in which fibroblast proliferation occurs, leading to an increase in numbers of fibrocytes in the renal cortical interstitium and thus to increased production of collagen.

Creatinine↗
PubMed1990

[Etiopathogenesis of adhesions. Aspects of analysis of the literature 1888 to 1989].

Despite surgical efforts over a century, peritoneal adhesions are still an unsolved problem. Pathogenetic aspects derived from an analysis of the literature (700 papers, 1888-1989) are discussed: Two basic mechanisms play a role. Inhibition of the physiological regeneration of mesothelial defects and depression of peritoneal fibrinolytic activity mainly by ischemia and inflammation. Fibrinolysis in due time prevents the fibrinous adhesions from being transformed into fibrous ones. - All prophylactic and therapeutic measures have to be evaluated regarding these factors.

Abdomen↗
PubMed1983

[Crohn disease - value of coloscopy to the surgeon].

In a total of 1105 coloscopies, performed from 1977 to 1980, 36 patients with Crohn's disease could be found. 18 of them had an isolated involvement of the colon. In most cases coloscopy proved to be an important aid for surgical management. Using graded biopsies the diagnosis can be confirmed or excluded, despite the fact that Crohn-specific granulomas were seen only in 10 of 32 patients. The specificity of fistulas and stenoses can also be determined by coloscopy. With radiology producing false positive (4) and false negative (5) results in 30 patients, coloscopy in contrast proved to be the better diagnostic tool (2 false neg.). Every patient with Crohn's disease should be investigated preoperatively by additional coloscopy and biopsy.

Biopsy↗
PubMed1983

Extrabiliary obstructive jaundice.

Extrabiliary obstructive jaundice is only encountered in biliary digestive anastomosis when the draining bowel itself is obstructed. In two patients, the cause of obstruction was a local tumour recurrence.

Adult↗
PubMed1982

[Treatment of functional ileus: adrenergic blockade and stimulation (author's transl)].

Intestinal stimulation is among the basic therapeutic procedures in functional ileus. But the majority of cases of functional ileus is due not to paralysis but to adrenergic inhibition. Thus the primary treatment should not be to stimulate but to act against the inhibition. In over 100 patients a combined treatment schedule consisted of primary adrenergic blockade (trifluperidol, dihydroergotamine or chlorpromazine) followed by low doses of stimulants (ceruletide, neostigmine). 52 patients who had not responded to high doses of peristalsis-stimulating drugs acted as their own controls: in 48 of them intestinal function was restored by sympathicolysis. If indications and application are properly observed the method has a low risk and provides effective treatment of functional ileus, especially in cases resistant to other forms of treatment.

Adolescent↗
PubMed1982

[Morphometrical investigations on bowel interpositions after total gastrectomy (author's transl)].

Different types of interposition were performed on beagle dogs as stomach substitutes after total gastrectomy: (1) interposition of jejunal segment, (2) interposition of ileocecal region, (3) interposition of colon segment, and (4) jejunal segment according to Roux-en-Y configuration. The interpositions were evaluated morphometrically at defined sites 3 months after the operation. One of the most evident changes found in the interposed intestinal segment was strong hypertrophy of the circular muscular layer. In interposed colon segment the hypertrophy was less than in jejunal ones. The volume burden the newly formed stomach exposed to seems to be the pathogenetic factor responsible for this change. A change in villous morphology was shown with a reduction of the surface of the intestinal mucosa. Simultaneous enlargement of crypts presented a picture similar to the partial mucosal atrophy of the hyperregenerative type. In contrast, the mucosa of the colon interpositions was regular and showed no evident structural change. The alterations of the small intestinal mucosa seem to be induced mainly by differences in the intraluminal milieu. Besides the volume burden insufficient chyme digestion may be responsible for local malnutrition of the mucosa, which results in a morphological change. The hypertrophy of the muscular layer can be interpreted as adaptation to the reservoir function and the degeneration of small intestinal mucosa, as caused by trophic interference.

Animals↗
PubMed1981

[Gastrointestinal perforations in the newborn (author's transl)].

Between 1958 and 1979, 48 neonates with gastrointestinal perforation were treated in the University Clinic, Mainz. The high rate of premature births (c. 40%) was noteworthy, as were the frequent complications in the perinatal period. An accurate diagnosis was made more difficult by the peculiarities of this age, and the multipilicity of possible causes of perforation. The first clinical symptoms were non-specific. In only 36% of the patients was the so-called "pathognomonic" pneumoperitoneum diagnosed on X-ray. The most common site of perforation was the ileo-coecal region, the commonest causes of perforation were intestinal obstruction (atresias, Hirschsprung's disease) and necrotising enterocolitis. In almost 1/3 of all children, the exact causes of perforation could not be determined from the history, intra-operative findings, or histology. The operative procedure depends on the individual case. It must be suited to the site and cause of the perforation, and to the subsequent disturbances. Of the post-operative complications, those related to paediatric intensive-care proved to be more serious than the directly surgical complications. The total mortality was, at 63%, high. The main cause of death was found to be septicemia, and septic complications. An improvement in the results can only be attained through early diagnosis, immediate operation and peri-operative intensive care.

Female↗
PubMed1981

Correlations between renal cortical interstitial fibrosis, atrophy of the proximal tubules and impairment of the glomerular filtration rate.

This study has confirmed impairment of the glomerular filtration rate (GFR) (increase of the serum creatinine concentration) by fibrosing processes in the renal cortical interstitium. In addition statistically significant correlations were found between the decrease of the total area of the proximal tubules and of the area of the epithelial cells and both the extent of the renal cortical interstitial fibrosis and the serum creatinine concentration. Further statistically significant positive correlations were observed between the age of the patients and both the grade of interstitial fibrosis and the serum creatinine concentration. No correlation could be established between the age of the patients and the total area of the epithelial cells of the proximal tubules. Pathogenetically it is conceivable that with progressive interstitial fibrosis the tubules become atrophic as a result of malnutrition. The function of these atrophied tubules may be disturbed, the reabsorptive capacity for NaCl impaired and consequently the GFR reduced not only by slowing of the glomerular blood flow secondary to interstitial fibrosis, but also by the tubular-glomerular feedback-mechanism.

Acute Kidney Injury↗
PubMed1980

Structure and function of the kidney in diabetic glomerulosclerosis. Correlations between morphological and functional parameters.

Histological and clinical findings in 103 middle-aged patients suffering from diabetic glomerulosclerosis (gs) (biopsy material) are reported. In diabetic gs (as in other inflammatory and non-inflammatory glomerular disease) a statistically highly significant positive correlation exists between the grade of fibrosis of the renal cortical interstitium and the serum creatinine concentration at the time of biopsy. Rank correlations exist between vessel index and relative cortical interstitial volume on the one hand as well as serum creatinine concentration on the other. Significant differences are also shown to exist between the mean values of the cortical interstitium as well as the serum creatinine concentration and the vessel index in the four grades of diabetic gs. Severe glomerular lesions may be accompanied by a normal serum creatinine concentration, only if the interstitium shows no fibrotic changes. Mild glomerular lesions, when accompanied by an interstitial fibrosis, always have elevated serum creatinine concentrations. The incidence of hypertension, proteinuria, the nephrotic syndrome and hematuria in diabetic gs appears to vary greatly. From the highly significant correlation between the cortical interstitium and the serum creatinine concentration we presume the following: Alterations of the postglomerular vessels by interstitial fibrotic changes result in an increased resistance to renal cortical blood flow with a subsequent reduction of glomerular perfusion. This reduction of the glomerular perfusion may result in a rise of the serum creatinine concentration, independently of the severity of the glomerulosclerosis. It is also conceivable that glomerular function is affected by the malfunctioning atrophic tubules in areas of interstitial fibrosis.

Biopsy↗