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Biomedical subjects

K H Fuchs

Publications and source records attributed to K H Fuchs.

At least 109 records · Page 6Linked to original sources
PubMed1991

Randomized comparison of endoscopic palliation of malignant esophageal stenoses.

In a randomized study, palliative therapy of malignant esophageal and gastric stenosis was investigated by a comparison of endoscopic laser therapy (ELT) with palliative endoscopic perturbation (PEP). A total of 124 patients exhibiting a malignant stenosis in the esophagus and proximal stomach were referred to our unit between January 1, 1987, and March 31, 1990. Criteria for randomization were: (1) inoperable malignant stenosis, (2) dysphagia enabling the ingestion of semi-solid food, (3) the possibility of performing ELT and PEP, and (4) the absence of fistula formation. Only 40 patients met these criteria; the remaining 84 subjects were assigned to an escape group whose treatment consisted of ELT, PEP, percutaneous endoscopic gastrostomy, transnasal feeding tube, radiotherapy, and endoscopic bougienage. We found no significant difference between ELT and PEP with regard to survival, food passage, or quality of life. We recommend the application of PEP in patients exhibiting advanced tumor disease and a poor general condition and favour the use of ELT combined with afterloading in patients with a life expectancy of greater than or equal to 3 months.

Adenocarcinoma↗
PubMed1991

Computerized identification of pathologic duodenogastric reflux using 24-hour gastric pH monitoring.

Duodenogastric reflux is a naturally occurring sporadic event, the incidence, occurrence, and detrimental effects of which have been difficult to assess. The reliability of 24-hour gastric pH monitoring to detect duodenogastric reflux was studied. Central to the use of pH monitoring for this purpose is confidence in its ability to measure and display pH data in a way that reflects changes in the gastric pH environment with sufficient sensitivity. To test this the gastric pH of 10 dogs was measured in the fasting state, after feeding, and after pentagastrin stimulation. The antrum was more alkaline in the fasting state (p less than 0.01) and the display of data by frequency distribution graph was sensitive enough to reflect induced pH changes. To test the consistency of gastric pH at a given position, simultaneous 24-hour gastric monitoring was performed in 12 normal subjects with two probes placed at either 5 or 10 cm below the lower esophageal sphincter. Only at the 5-cm position did the two probes read within 1 pH unit of each other more than 90% of the time. Based on these principles, gastric pH monitoring was performed 5 cm below the lower esophageal sphincter in 30 normal subjects and 11 patients, fulfilling Ritchie's clinical criteria for pathologic duodenogastric reflux. The data obtained was arranged into 71 variables and subjected to discriminant analysis. Sixteen variables were identified, each with a corresponding coefficient to be used as a multiplier to derive a score. A score of more than +2.2 indicated a high probability of pathologic duodenogastric reflux. The test was applied to a validation population consisting of 10 additional normal subjects and 10 patients meeting Ritchie's criteria. All normal subjects had a normal score and all but one (90%) of the patients had an abnormal score. When compared to O-diisopropyl iminodiacetic acid (DISIDA) scintigraphy in another group of 22 normal subjects and 60 patients, 24-hour gastric pH monitoring was superior in the detection of pathologic duodenogastric reflux. The study shows how the application of computer technology can be used to diagnose pathologic duodenogastric reflux in patients with complex foregut complaints.

Animals↗
PubMed1990

Clinical use of 24-hour gastric pH monitoring vs o-diisopropyl iminodiacetic acid (DISIDA) scanning in the diagnosis of pathologic duodenogastric reflux.

The efficacy of o-diisopropyl iminodiacetic acid (DISIDA) scanning was compared with that of computerized analysis of 24-hour gastric pH monitoring to diagnose excessive duodenogastric reflux in 22 normal volunteers and 106 consecutive patients with foregut symptoms. DISIDA scanning had a false-positive rate of 18% in the normal volunteers. Gastric pH monitoring showed an increasing prevalence of duodenogastric reflux in patients with increasing clinical evidence of this condition, which was not seen with DISIDA scanning. Both DISIDA scanning and gastric pH monitoring identified duodenogastric reflux in most patients who had had previous pyloroplasty or antrectomy. Only gastric pH monitoring, however, showed a significantly increased prevalence of duodenogastric reflux in symptomatic patients after previous cholecystectomy compared with those who had not undergone previous surgery. These data suggest that 24-hour gastric pH monitoring is superior to DISIDA scanning in identifying duodenogastric reflux as a cause of foregut symptoms.

Adolescent↗
PubMed1990

Intragastric pH pattern analysis in patients with duodenogastric reflux.

The intention of the present study was to apply 24-hour intragastric pH monitoring as a diagnostic tool for the detection of pathologic duodenogastric reflux. Therefore, an evaluation system was developed which is able to recognize and quantify specific intraluminal gastric pH patterns regarding their specificity for the disease. pH parameters, stored during 24 h and processed, according to the evaluation system, were obtained for a healthy control population (n = 30) and for patients with pathologic duodenogastric reflux (n = 11). These data were subjected to computerized discriminant analysis to identify pH changes with a high probability of resulting from pathologic duodenogastric reflux. The computer analysis identified 16 discriminating pH parameters to separate a physiologic pH pattern from a 24-hour intragastric pH pattern with a high probability of being associated with pathologic duodenogastric reflux.

Adult↗
PubMed1990

[Esophageal tube in inoperable esophageal and cardia cancer: indications and technique].

Endoscopic tube implantation remains still one of the alternatives in palliation of inoperable patients with malignant stenosis of the esophagus and cardia. Although LASER-treatment has less complications, patients in poor general condition, patients with tracheo-esophageal fistulas, patients with external compression of the esophageal lumen, are clear indications for tube implantation. The right choice of palliative technique should depend on the individual situation of the patient.

Cardia↗
PubMed1989

[Technical prerequisites for performing controlled studies with the goal: postoperative quality of life after gastrectomy].

A study of 78 cases of gastrectomy in which two reconstruction procedures Roux-en-Y + pouch and interposition + pouch were compared and which is still in progress, yielded the following results: 1. It is possible to use both methods only with staplers and have few complications in a time-saving procedure. 2. A Roux-en-Y + pouch takes mean = 50 min; an interposition + pouch requires mean = 90 min (net time of reconstruction). 3. It is sometimes impossible for anatomical reasons to use an interposition + pouch. 4. The more complex procedure--the interposition + pouch--does not have a higher rate of complications. 5. Technical development permits controlled studies investigating the long-term target: quality of life.

Anastomosis, Roux-en-Y↗
PubMed1989

[Gastrointestinal hemorrhage--change in therapy concepts by endoscopy].

Since the introduction of endoscopy in diagnosis and treatment of gastrointestinal bleeding in the early seventies, emergency endoscopy has changed the therapeutic concept of this disease. At first the task of emergency endoscopy was limited to location of the bleeding site. In the eighties endoscopic hemostasis was established in many hospitals. In addition, preselection of patients who will benefit from surgery has become possible by endoscopic means. These factors have reduced significantly mortality due to GI bleeding.

Endoscopes, Gastrointestinal↗
PubMed1989

[Diagnosis and therapy of gastrointestinal hemorrhage].

In the upper gastrointestinal tract endoscopic hemostasis has not replaced surgery, but reduced it to a necessary minimum. Active bleeding can be stanched by the injection method during emergency endoscopy. For bleeding esophageal varices we use polidocanol, in other lesions in the upper gastrointestinal tract we apply thrombin and in the lower intestinal tract adrenalin. If endoscopic hemostasis is successful in small bleeding vessels, the efficiency of hemostatic injections can be trusted. Large visible vessels need to be operated early electively. After the introduction of this therapeutic concept, for example the operation frequency in bleeding gastroduodenal ulcers could be reduced from 51% in 1982 to 28% in 1988. Mortality was improved from 22.1% to 4.7%. In gastrointestinal bleeding diagnostic problems occur especially with angio dysplasia in the small intestine and colon. This is due to impaired accessibility in the small intestine and problematic cleaning of the colon. In the intestine surgical therapy of bleeding lesions has very few alternatives, for example palliative embolization of infusion of vasoconstrictiva.

Emergencies↗
PubMed1987

Pouch and Roux-en-Y reconstruction after gastrectomy.

We evaluated a reconstruction procedure of the upper gastrointestinal tract after total gastrectomy with the exclusive use of the EEA, GIA, and TA surgical stapling devices (United States Surgical Corp, Norwalk, Conn). Twenty patients with gastric carcinoma entered the study. A total gastrectomy and lymphadenectomy was performed in each patient and the upper gastrointestinal tract was reconstructed by the Roux-en-Y technique with the creation of a Hunt-Lawrence-Rodino pouch. For all operational steps, surgical staplers were used exclusively, as follows: (1) duodenal closure, GIA or TA; (2) Roux-en-Y anastomosis, EEA 25; (3) pouch construction, GIA (three to four times); (4) esophagojejunostomy, EEA 25; and (5) pouch closure, TA 55 or 90. There was a one-hour difference in operating time between patients operated on exclusively by the staple technique and TNM-matched patients operated on manually. Four patients suffered from general complications. Two patients had clinically relevant suture deficiencies. We concluded that current reconstruction methods after gastrectomy that fulfill the reservoir function (pouch) and reflux prevention (Roux-en-Y reconstruction) can be achieved by the combination and systematic use of straight and circular staplers. The advantages are intraoperative time saving and a relaxation of limitations imposed on an abdominal intervention by age and localization of the tumor.

Adult↗
PubMed1987

Experimental and clinical results with proximal end-to-end duodenojejunostomy for pathologic duodenogastric reflux.

Existing Roux-en-Y bile diversion procedures for duodenogastric reflux coupled with distal gastric resection or antrectomy and vagotomy have varied success due to interruption of the physiologic relationships between stomach and duodenum, the reduction of the gastric reservoir, the side effects of vagotomy, and the effect of the Roux limb on gastric emptying. A new bile diversion procedure, suprapapillary Roux-en-Y duodenojejunostomy, was studied, which eliminates the need for gastric resection to prevent jejunal ulcers by preserving duodenal inhibition of gastric acid secretion and the protective effects of duodenal secretion on the surrounding mucosa. Experimentally, the incidence of jejunal ulceration was significantly decreased by the preservation of the proximal duodenum. Clinically, bile diversion by suprapapillary Roux-en-Y duodenojejunostomy alleviates symptoms of duodenogastric reflux disease without being ulcerogenic (in the presence of normal gastric secretion) or prolonging gastric emptying.

Adult↗
PubMed1987

[Primary immediate coverage of decubitus ulcers by musculocutaneous flaps and gentamicin PMMA beads].

Myo- or fasciocutaneous flaps for coverage of longstanding pressure sores in para- or quadriplegic patients have been proved superior to cutaneous flaps. Pretreatment with ulcer-debridement and systemic antibiotics for urinary-tract-infection and septicaemia was thought to be necessary for successful closure of these difficult defects. In a prospective, clinical trial 17 patients with 20 pressure sores were treated this way during 1980-1983. From 1983-1985 no local or antibiotic treatment was given to a second group of 20 patients with 28 decubitus ulcers prior to a one-stage-closure of the pressure sores. Only five patients with septicaemia above 39 degrees C received antibiotics intraoperatively. Gentamicin-PMMA-beads were temporarily inserted under the myo- or fasciocutaneous flaps during the procedure. If necessary, urinary-tract-infection was treated after successful coverage. Both groups have been compared historically. There were less wound complications in the second group while a median time-saving of 2 1/2 weeks per patient could be gained, even though they had larger pressure sores, frequent bone involvement, and multiple ulcers in this group.

Adolescent↗
PubMed1987

[Endoscopic removal of an ingested foreign body--indications and choice of procedure].

The majority of ingested foreign bodies does not cause problems for the patients and leaves the gastrointestinal tract spontaneously without complications. However the low risk of modern fiberendoscopy allows a safe approach of endoscopic extraction. In children and all other cases, where general anesthesia is required for the extraction procedure, indication for endoscopic extraction should be limited. From 1980-1986 we followed a concept, which differentiated for emergency, early-elective or elective extraction, depending on localisation and nature of the foreign bodies as well as the necessity for general anesthesia. In 88 endoscopic extractions (22 emergency, 66 elective) no complications were observed.

Adult↗
PubMed1987

Specificity and sensitivity of objective diagnosis of gastroesophageal reflux disease.

To evaluate the diagnostic value of different tests for gastroesophageal reflux disease, a test population was constructed from 45 patients with symptoms of heartburn and regurgitation with or without esophagitis and 45 healthy subjects, who never experienced heartburn, regurgitation, or swallowing discomfort. The test population underwent esophagoscopy, standard acid reflux test, 24-hour pH monitoring, and manometry of the lower esophageal sphincter. Sensitivity, specificity, positive predictive value, negative predictive value, and the accuracy of the tests and test combinations were calculated. Esophagoscopy had a sensitivity of 62%, that is, only 62% of patients with the disease have evidence of mucosal damage on endoscopy. Manometric measurements of the lower esophageal sphincter had a sensitivity of 84%, a specificity of 89%, and an accuracy of 87%. Twenty-four hour esophageal pH monitoring had a sensitivity, specificity, and accuracy of 96%. The results show that 24-hour pH monitoring can detect gastroesophageal reflux disease with an accuracy of 96% by measuring an increase in esophageal acid exposure. Manometry of the lower esophageal sphincter can detect a mechanically deficient sphincter as a cause of the disease with an accuracy of 87%. The test combination of 24-hour monitoring and motility studies can select patients with an accuracy of 91% who have an increase in esophageal exposure to gastric juice because of a deficient cardia. Antireflux surgery is designed to reduce esophageal exposure to gastric juice in patients with a deficient sphincter by creating a mechanical antireflux mechanism at the cardia. Therefore it is necessary to determine the mechanical status of the sphincter with manometry before surgery in such patients. Thus the indications for antireflux surgery are (1) uncontrolled symptoms of increased esophageal exposure to gastric juice; (2) a documented increase in esophageal exposure to gastric juice by 24-hour pH monitoring; and (3) a mechanically defective sphincter on motility with a pressure of 6 mm Hg or less, an overall length of 2 cm or less, and an abdominal length of 1 cm or less.

Esophagoscopy↗
PubMed1986

[Roux-Y reconstruction following distal stomach resection using only staplers].

The spreading of stapled suture techniques has also entailed the utilization of staplers in gastric surgery. A functional, up-to-date, and exclusively stapled reconstruction procedure, Roux-Y-reconstruction, after subtotal gastrectomy was established and analyzed in a pilot study (n = 25). In doing so, one proceeded as follows after subtotal gastrectomy and systematic lymphadenectomy in cases of carcinoma: duodenal closure (GIA or TA30), gastric resection (TA90), jejunojejunostomy (EEA25), gastrojejunostomy (EEA25/28), closure of the projecting efferent loop (GIA). This study intended to achieve the following advantages: increased suture safety, saving of time, reduction of complications, and especially the extension of indications regarding age and localization of the tumor. A special program to eliminate mistakes in handling is required for the sole and systematic application of staplers in the upper gastrointestinal tract. Every complication occurring during and after surgery was carefully recorded in this study and the attainable quality of life after subtotal gastrectomy was assessed.

Adult↗
PubMed1985

[Hemorrhage of esophageal varices in child B and C patients. Results of sclerosing therapy].

In a 3-years period 51 patients with acute bleeding oesophageal varices with Child-stadium B and C were admitted to our department. Endoscopic sclerosing therapy was performed during emergency endoscopy. --The analysis of these patients indicates, that unsuccessful conservative treatment before endoscopic sclerosing therapy has a negative influence on the outcome of our patients. This fact should be kept in mind when results of this study are compared with other studies. Fatal prognostic criteria are early recurrent bleeding within the first 24 h after emergency endoscopy, thrombocytopenia and a deficiency of fibrinogen. The latter is an indication for ballon tamponade of the varices in the distal oesophagus even after successful endoscopic hemostasis.

Adult↗