Future perspectives of minimal invasive surgery.
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Gastrointestinal Diseases↗
Biomedical subjects
K H Fuchs
Publications and source records attributed to K H Fuchs.
Crystalline mitochondrial inclusion bodies isolated from creatine depleted rat soleus muscle.
Rats were fed a 2% guanidino propionic acid diet for up to 18 weeks to induce cellular creatine depletion by inhibition of creatine uptake by this creatine analogue. Ultrastructural analysis of creatine depleted tissues showed that mitochondrial intermembrane inclusion bodies appeared in all skeletal muscles analysed, after 11 weeks of feeding. Heart had relatively few even after 18 weeks of analogue feeding and none were evident in kidney, brain or liver. These structures were strongly immuno-positive for sarcomeric mitochondrial creatine kinase and upon removal from mitochondria, the inclusion bodies were shown to diffract to a resolution of 2.5 nm. Two-dimensional image analysis and three-dimensional reconstruction revealed arrays of creatine kinase octamers with additional components between the octameric structures. The same mitochondria had a 3-fold higher extractable specific creatine kinase activity than controls. Molecular mass gel filtration of inclusion body containing mitochondrial extracts from analogue fed rat solei revealed mitochondrial creatine kinase eluting as an aggregate of an apparent molecular mass > or = 2,000 kDa. Mitochondrial creatine kinase of control soleus mitochondrial extract eluted as an octamer, with a molecular mass of 340 kDa. Respiration measurements of control solei mitochondria displayed creatine mediated stimulation of oxidative phosphorylation that was absent in analogue-fed rat solei mitochondria. The latter also had 19% and 14% slower rates of state 4 and maximal state 3 respiration, respectively, than control mitochondria. These results indicate that mitochondrial creatine kinase co-crystallises with another component within the inter membrane space of select mitochondria in creatine depleted skeletal muscle, and is inactive in situ.
Adenylate Kinase↗
[Quality assurance and cost benefit analysis of viscerosynthesis].
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Abdomen↗
[Practical and theoretical aspects of cost-benefit relations in viscerosynthesis].
The necessity of limiting health care costs requires adequate service recording and quality control even in visceral surgery. In this field, the safety of the anastomoses is of greatest importance. Anastomoses at risk are esophageal connections to jejunum or colon and deep rectal anastomoses. At these locations expensive suture devices, such as stapling instruments, can be used in a cost saving aspect, if they help to increase anastomotic safety, time saving and expansion of surgical indication. Manual sutures thus represent the cheapest anastomotic technique as continuous sutures would cost between DM 10.- to 20.- and single stitch sutures between DM 60.- and 100.-. A surgical school should prevalently aim at training manual anastomoses, while special anastomotic techniques should only complete the skill for selected indications. The overall staff expenditure for extended operations amounts around DM 600.- per hour respectively DM 10.- per minute. Time for surgery might be shortened by auxiliary tools as much as to perform an additional operation. However, a circular stapler anastomosis that costs between DM 650.- to 850.- is twice as expensive as manual sutures notwithstanding the double time needed. In the past years, the necessity for a rational use of different anastomotic techniques has shown to be mandatory since, increasingly, financial aspects of health economy require cost benefit calculations in visceral surgery.
Abdomen↗
[Current and controversial aspects of minimal invasive surgery].
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Cost Control↗
[Laparoscopic interventions in gastroesophageal reflux--a cost-benefit analysis].
On the basis of a cost analysis of conservative and surgical therapy of gastroesophageal reflux disease in 70 patients health economic aspects are discussed. In a prospective documented series of reflux patients a retrolective analysis of medication cost and duration of conservative therapy is performed. In addition, the costs for surgical therapy including preoperative diagnostic workup, cost during hospitalization as well as costs for complications with necessary additional treatment and readmissions are assessed. For the conservative treatment of 70 reflux patients a total of more than DM < 700,000 had to be spent during preoperative 5 years. A major part of this sum was spent for patients who needed to increase the initial 20 mg dosage of Omeprazol within 5 years. A mean of approximately DM 2,000 per patient was spent for conservative treatment. Surgical treatment without complications was calculated with DM 5,425 per case. However, in 7 patients complications occurred causing prolonged or even rehospitalization with necessary further treatment summing up to about DM 486,000 for surgical therapy in 70 patients including complications. Cost relevant factors are therefore in conservative treatment patients who need increasing dosages, while, in surgical treatment, the cost relevant patients are those with complications and necessary additional treatment.
Adolescent↗
[Regional cooperation in molecular biology topics].
Research on rare events, such as the occurrence of port-site metastases, can be speeded up by pooling patients from different hospitals. Multidisciplinary approaches, involving surgeons, pathologists and molecular biologists, allow more detailed experimental results to be obtained. Research costs are kept low by using existing infrastructures over a short period of time.
Cost-Benefit Analysis↗
[How expensive is treatment of reflux disease?].
In a prospective documented series of reflux patients, a retroelective analysis of medication cost and duration of conservative therapy as well as the costs for surgical therapy including preoperative diagnostic workup, cost during hospitalization, and costs for complications with necessary additional treatment and readmissions is assessed. Cost-relevant factors are in conservative treatment cost-relevant factors are those patients who need increasing dosages, while in surgical treatment the cost-relevant patients are those with complications who need additional treatment.
Anti-Ulcer Agents↗
[Is perforating appendicitis a separate disease picture?].
Large epidemiological studies recently published suggest that perforating appendicitis may represent a separate disease entity. To find out whether perforating and nonperforating appendicitis may be distinguished by clinical features (history and examination, lab tests) data from 519 cases of acute appendicitis (17.7% perforations) were analysed, and significant differences were recorded in various aspects of history and clinical examination. It was concluded that perforating and nonperforating appendicitis may clinically be distinguished reliably in the majority of cases.
Adult↗
Surface topographies at subnanometer-resolution reveal asymmetry and sidedness of aquaporin-1.
Aquaporin-1 (AQP1) is an abundant protein in human erythrocyte membranes which functions as a specific and constitutively active water conducting pore. Solubilized and isolated as tetramer, it forms well-ordered two-dimensional (2D) crystals when reconstituted in the presence of lipids. Several high resolution projection maps of AQP1 have been determined, but information on its three-dimensional (3D) mass distribution is sparse. Here, we present surface reliefs at 0.9 nm resolution that were calculated from freeze-dried unidirectionally metal-shadowed AQP1 crystals as well as surface topographs recorded with the atomic force microscope of native crystals in buffer solution. Our results confirm the 3D map of negatively stained AQP1 crystals, which exhibited tetramers with four major protrusions on one side and a large central cavity on the other side of the membrane. Digestion of AQP1 crystals with carboxypeptidase Y, which cleaves off a 5 kDa intracellular C-terminal fragment, led to a reduction of the major protrusions, suggesting that the central cavity of the tetramer faces the outside of the cell. To interpret the results, sequence based structure predictions served as a guide.
Aquaporin 1↗
The mode of Roux-en-Y reconstruction affects motility in the efferent limb.
OBJECTIVES: To compare motility of a Roux-en-Y esophagojejunostomy after total gastrectomy with normal jejunal motility and to determine the effect on motility of the incorporation of a pouch in the reconstruction. DESIGN: Jejunal motility in normal subjects was compared with jejunal motility in the Roux-en-Y reconstruction with and without a Hunt-Lawrence pouch. SETTING: The case were collected during a 4-year period at a university hospital. The mean time from resection to study was 14 months (range, 4 to 49 months). PATIENTS: Seven control patients were compared with 10 patients with a Roux-en-Y reconstruction and 17 with a Roux-en-Y and Hunt-Lawrence pouch. OUTCOME MEASURE: The fasting-state motility of the jejunum used for reconstruction was measured by a water-perfused manometric system for 2 to 4 hours with the subject in the supine position. RESULTS: Compared with normal subjects, patients with a Roux-en-Y esophagojejunostomy without a pouch had an increased number of phases of the interdigestive motor complex per hour (P < .05). The phases were of shorter duration with a random sequence and increased total time spent in the quiescent phase 1 (P < .05). In patients with a pouch, no differences were detected between the motility in the pouch and the efferent limb. Compared with those without a pouch, there were significantly fewer orthograde interdigestive motor complex phase 3 fronts and more total time spent in phase 1 (P < .05). CONCLUSIONS: Construction of a gastric substitute from jejunum leads to substantial motility changes. The addition of a pouch decreases the overall activity, which may contribute to the storage function of the pouch.
Adult↗
Fiberoptic technique for 24-hour bile reflux monitoring. Standards and normal values for gastric monitoring.
Physiologic bile reflux was assessed in 27 in vivo test with healthy volunteers to define a standardized protocol and normal values for 24-hour enterogastric bile reflux monitoring (protocol with supine, upright, and meal phases and a free diet avoiding alcohol, smoking, and coffee, evaluation with different thresholds of absorbance units: 0.14, 0.25). In vitro tests with bile-sodium solutions demonstrated a linear dependence of absorbance for bilirubin up to 600 mumol/liter (range of the fiberoptic device: 0.0-1.0). Fluids and food might interfere with absorbances below 0.25 (exception: coffee). In vivo bile often remains in the stomach for more than 1 hr; these events were defined as reflux episodes. The upper limits for physiologic bile reflux are a percentage of total time of bile reflux of 28.2% and an average absorbance during a reflux episode of 0.62 (95th percentile with threshold 0.25). Comparing bile with pH monitoring (absorbance > 0.25 and/or pH > 4), an increase of bilirubin was found most frequently with constant pH (45%) or an increase of pH with constant bilirubin (36%). The hypothesis was drawn that bile and duodenal or pancreatic secretions may separately contribute to duodenogastric reflux.
Adult↗
[Differential concept on use of laparoscopic anti-reflux operations].
The introduction of laparoscopic technique in antireflux surgery has created hope for an improvement in patient outcome. Initial experience with minimally invasive procedures show that the application in antireflux surgery depends more on a differentiated indication for operation and an operative procedure designed to remove or compensate the underlying pathophysiologic functional defect. The method of access is of lesser priority. The promising results of this series may encourage continuation of the demonstrated protocol and operative technique.
Adult↗
[Etiology and epidemiology of anal incontinence].
Current epidemiological data about fecal incontinence are reviewed. Anatomy and physiology of the anal sphincter are described, and it is shown that continence relies on several interdependent anatomical and functional factors. Etiology of fecal incontinence is discussed and illustrated by clinical examples.
Diagnosis, Differential↗
[Endo-anal sonography in diagnosis of fecal incontinence].
Endoanal ultrasound is a new imaging technique in the diagnostic work-up of patients suffering from anal incontinence. A standardised examination as well as hardware specific reference values for the sphincter muscles are of paramount importance to allow correct interpretation of the continence organ. At the University Hospital of Würzburg from 1.2.1993 to 31.7.1994 90 patients (50 male, 40 female; age: 16-81 y.) with normal continence underwent endosonographic assessment of their sphincter complex. We measured the internal anal sphincter (IAS), puborectalis muscle as well as the three separate parts of the external anal muscle (EAS). Apart from establishing reference values we found a significant increase in thickness of both EAS and IAS with increasing age. However, no correlation was seen between muscle thickness, sex, height or weight. We also examined 29 patients with a history of incontinence. 13 (45%) had a morphological sphincter defect, most of which were due to obstetric trauma or previous proctological operations. 10 (35%) patients suffered from so called idiopathic incontinence. Anal ultrasound in these patients revealed muscle hypotrophy of the structurally intact sphincters.
Adolescent↗
[Anorectal pull-through and vector volume manometry].
Anorectal manometry has been developed from an object of clinic oriented scientific interest to an established tool within the spectrum of proctologic diagnostics. At present it represents the only objective diagnostic method with regards to continence disorders; it is routinely applied in the evaluation of constipation, of incontinence, of pre- and postoperative conditions in diseases of the anorectum as well as in the indication and therapeutic control investigations during biofeedback training of the anal sphincter. The new technique of determination of the anal sphincter pressure vector volume allows for the most sensitive functional separation of patients with different degrees of continence; this method delivers a 3-dimensional graphic imaging of the sphincter pressure profile, thus allowing for an objective visualisation of the present mechanic defect and an aid in planning a surgical correction.
Anal Canal↗
[Surgical therapy of rectal prolapse].
A review of literature and own clinical studies confirm that best postoperative functional results in complete rectal prolapse may be reached with rectopexy in combination with partial resection of the colon. Incontinence may be improved in 38% to 93%, depending on the author. Constipation may be reduced in 41% to 83% of the cases. In comparison, rectopexy without resection resulted in a reduction of constipation of only 11% to 28%, with even a change to the worse in 60% of the patients. Improved operative and anesthesiological conditions cause an acceptable perioperative morbidity (7-13%) and mortality (0-2%) after rectopexy with partial resection of the colon.
Colon↗
[Therapy of upper gastrointestinal fistulas with simultaneous abdominal wall defects].
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Abdominal Muscles↗