Search PubMed⌕ Search

Biomedical subjects

K H Fuchs

Publications and source records attributed to K H Fuchs.

119 records · Page 7Linked to original sources
PubMed1984

[The injection method for hemostasis in gastroduodenal lesions. Indications and possibilities].

Endoscopic injection of polidocanol was used in a prospective study of 88 patients with gastroduodenal bleeding. Active bleeding by injecting polidocanol (1%) in 54 patients achieved initial haemostasis in 51 (94%); lasting arrest of bleeding was achieved in 39 (72%). This injection treatment was also used to prevent recurrence of bleeding where there had been signs of previous bleeding: this proved successful in 25 of 34 patients (74%). The endoscopic injection method thus gave results equivalent to other endoscopic methods of achieving haemostasis.

Emergencies↗
PubMed1984

[The concept of endoscopy-related therapy in gastroduodenal ulcer hemorrhage].

In a prospective study a new therapeutic concept was tested on 76 patients with bleeding gastroduodenal ulcers. During emergency endoscopic an exact inspection of the ulcercrater helped to determine the possibility of recurrent bleeding of the ulcer. This possibility was expressed in a modified Forrest-classification. Endoscopic hemostasis has been performed in all cases of active bleeding. Ulcers with a big visible vessel stump should be operated early elective after an intervall of intensive care, because definitive endoscopic hemostasis seemed not to be sufficient with this bleeding type. The new concept decreased the operation frequency of bleeding gastroduodenal ulcers from 51% in 1981/82 to 34% in 1983. Mortality of bleeding duodenal ulcers decreased from 18% to 8,6%, in bleeding stomach ulcers from 24% to 18%. Endoscopic hemostasis with injection therapy has proved to be most successfull in the F1b bleeding type.

Aged↗
PubMed1984

[Operation or conservative therapy? New aspects based on further differentiation of emergency endoscopy findings in hemorrhage of gastrointestinal ulcers].

In a retrospective study the clinical courses of 121 patients with bleeding peptic ulcers were reviewed. The possibility for endoscopic prediction of recurrent bleeding was evaluated. The criteria specific to recurrent hemorrhage, which we found in bleeding ulcers during emergency endoscopy, led us to a modification of the Forrest-classification. All spurting arterial bleedings, which could be stopped by endoscopic means and all lesions with a big visible vessel in the ulcer crater had a high risk of recurrent bleeding. Therefore early surgical treatment should be performed soon after stabilisation of all vital functions and compensation of the blood loss. The emergency endoscopy enables not only an accurate diagnosis, but also a prediction and prognostic judgement of recurrent bleeding. This will give the surgeon valuable informations on deciding an operative or conservative treatment.

Emergencies↗
PubMed1983

[Occlusion of chronic decubitus ulcers by musculocutaneous gluteus maximus flaps].

Early coverage of long-standing pressure sores in patients with paraplegia, multiple sclerosis and prolonged immobilisation due to fractures of the lower extremities should be performed in order to avoid further bone destruction and septic complications. Musculocutaneous flaps offer several advantages in covering infected soft tissue defects and proved to be superior to cutaneous flaps. Surgical repair of pressure sores requires a prospective selection of available musculocutaneous flaps. Planning should include the possibility of ulcer recurrence or of pressure sores in adjacent regions. Sacral and ischial pressure sores were covered by a musculocutaneous gluteus maximus flap in 11 patients.

Adolescent↗
PubMedDate not supplied

Reconstruction of the food passage after total gastrectomy: randomized trial.

Controversial results have been reported regarding the importance of the duodenal food passage after total gastrectomy. There are a number of experimental and clinical studies showing an advantage for the jejunal interposition between esophagus and duodenum. Others favor the Roux-en-Y reconstruction, as it is technically less demanding. The purpose of this study was the randomized comparison between two major reconstruction principles after total gastrectomy for gastric cancer (i.e., jejunal interposition with pouch versus Roux-en-Y pouch reconstruction). A group of 120 patients with gastric cancer were randomized and operated on during a 5-year period according to standardized operative protocols, using either a jejunal interposition with pouch (JIP) or the Roux-en-Y reconstruction with pouch (RYP). Endpoints of this study were operation time, intra- and postoperative problems and complications, patients' body weight, functional assessment, and quality of life. Of the 120 patients, 14 had to be withdrawn during the operation because only the Roux-en-Y reconstruction was technically possible. Finally, 53 patients with JIP were compared with 53 patients with RYP for the perioperative course. There were no significant differences between the two procedures (RYP and JIP) regarding complications (24.5% and 26.4%, respectively), mortality (3.8% and 1.9%, respectively), and operation time (4.35 hours and 4.40 hours, respectively). For long-term functional comparison 46 (RYP, n = 26; JIP, n = 20) patients were without recurrence after 3 years of survival. Comparison of body weight, Visick scoring, and the Spitzer Index also did not reveal any significant difference between the two operation methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

Combination of endoscopic argon plasma coagulation and antireflux surgery for treatment of Barrett's esophagus.

Columnar-lined epithelium with specialized intestinal metaplasia of the esophagus (i.e., Barrett's esophagus) is a premalignant condition caused by chronic gastroesophageal reflux disease. Progression of intestinal metaplasia may be avoided by antireflux surgery, whereas regeneration of esophageal mucosa could be achieved by endoscopic argon plasma coagulation (EAPC). The aim of this prospective study was to show the early results of a combination of EAPC and antireflux surgery. Thirty patients with Barrett's esophagus were treated between August 1996 and December 1999. Regeneration of esophageal mucosa was achieved with several sessions of EAPC under general anesthesia. All patients were receiving a double dose of proton pump inhibitors. Endoscopic follow-up was performed 6 to 8 weeks after the last session. Antireflux surgery (Nissen [n = 26] or Toupet [n = 4] fundoplication) followed complete regeneration of the squamous epithelium in the esophagus. One year after laparoscopic fundoplication and EAPC follow-up with endoscopy and quadrant biopsies of the esophagus, 24-hour pH monitoring and esophageal manometry were performed. All 30 patients showed complete regeneration of the squamous epithelium after a median of two sessions (range 1 to 7) of EAPC. Twenty-two patients underwent 1-year follow-up studies. All showed endoscopically an intact fundic wrap. Recurrence of a 1 cm segment of Barrett's epithelium without dysplasia was present in two patients, both of whom had recurrent acid reflux due to failure of their antireflux procedure. Our results indicate that the combination of EAPC and antireflux surgery is an effective treatment option in patients with Barrett's esophagus with gastroesophageal reflux disease. Long-term follow-up of this therapy is necessary to evaluate its effect on cancer risk in Barrett's esophagus.

Adult↗
PubMedDate not supplied

Quality of life following laparoscopic gastric banding in patients with morbid obesity.

In a prospective study of 188 patients with morbid obesity, the time-dependent changes in the quality of life of individual patients were analyzed following laparoscopic gastric banding (LGB). These 188 patients (148 females and 40 males; age 19 to 59 years; body mass index 33 to 72 kg/m(2)) underwent evaluation of the LGB according to a strict protocol that included psychological testing using standardized instruments, detailed medical evaluation, upper gastrointestinal function studies, and evaluation of quality of life using the Gastrointestinal Quality of Life Index (GIQLI). Following this evaluation, 73 patients (57 females and 16 males; age 37 years [range 19 to 59 years]; body mass index 48 kg/m(2) [range 37 to 72 kg/m(2)]) underwent LGB and were followed up for 2 years focusing on weight loss, postoperative morbidity, weight-related comorbidity, and quality of life. The results demonstrate that LGB is well able to allow for a significant loss of excess weight and a significant improvement in patients' quality of life, both after a rather short period of time after surgery and at a continuous rate throughout the follow-up. The price for this success that was found in approximately 90% of patients is a complication rate of 38%; 85% of these patients, almost one third of all patients, must undergo some type of revision surgery. However, once the complications are resolved, these patients achieve the same level of weight loss and improvement in quality of life as patients with an uncomplicated postoperative course.

Adult↗
PubMedDate not supplied

Variability in the composition of physiologic duodenogastric reflux.

Duodenogastric reflux has long been associated with various diseases of the foregut. Even though bile is often used as a marker, duodenogastric reflux consists of other components such as pancreatic juice and duodenal secretions. The aim of this study was to investigate the occurrence of duodenogastric reflux, its components, and the variability of its composition in normal subjects. Twenty healthy volunteers (7 men and 13 women) whose median age was 24 years underwent combined 24-hour bilirubin and gastric pH monitoring and intraluminal gastric aspiration. All probes were placed at 5 cm below the lower border of the lower esophageal sphincter. Aspiration was performed hourly and at any time when bilirubin and/or pH monitoring showed signs of duodenogastric reflux. Elastase and amylase were measured in the aspirate. All volunteers had episodes of physiologic duodenogastric reflux. A total of 70 episodes of duodenogastric reflux were registered with a median of three episodes (range 1 to 8) per subject. Most bile reflux occurred separately from pancreatic enzyme reflux. Pancreatic enzyme aspirate was significantly more often associated with a rise in pH in comparison to bile reflux (P <0.01). Duodenogastric reflux is a physiologic event with varying composition. Both bile and pancreatic enzyme reflux frequently occur separately. These findings could explain the disagreement regarding assessment and interpretation of duodenogastric reflux in the past. Thus monitoring of duodenogastric reflux requires more than the detection of just one component.

Adult↗
PubMedDate not supplied

The role of 24-hr gastric pH-monitoring in the interpretation of 24-hr gastric bile monitoring for duodenogastric reflux.

BACKGROUND/AIMS: Duodenogastric reflux is a physiologic phenomenon. For a number of years, alkalinization of the acidic intragastric pH environment, as assessed by 24-hour gastric pH-monitoring, was thought to be caused by duodenogastric reflux. The recent introduction of the fotooptic Bilitec system for intraluminal bilirubin measurement has created the possibility to directly quantify a component of duodenal juice. METHODOLOGY: In this study, 24-hour gastric pH-monitoring and 24-hour bilirubin monitoring were performed in healthy subjects. The upper limits for physiologic bile reflux are the 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). RESULTS: Comparing bile with pH-monitoring (absorbance > 0.25 and/or pH > 4), an increase of bilirubin was found most frequently with constant pH (43%) or an increase of pH with constant bilirubin (37%). CONCLUSIONS: The hypothesis was drawn that the composition of duodenogastric refluxate can vary. Bile and pancreatic juice may separately contribute to duodenogastric reflux.

Bile↗