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M Sailer

Publications and source records attributed to M Sailer.

At least 37 records · Page 2Linked to original sources
PubMed2001

Morphologic changes of the anal sphincter musculature during and after temporary stool deviation.

BACKGROUND AND AIMS: Temporary stool deviation, using a stoma, is a well-known surgical principle to protect low colorectal or coloanal anastomoses. The purpose of this study was to evaluate any morphologic changes with regard to the anal sphincter muscles during and after temporary ileostomy. PATIENTS AND METHODS: Forty-four patients with rectal carcinomas were studied prospectively. All patients underwent low anterior resection. Reconstruction was performed using either a coloanal pouch or a straight end-to-end anastomosis. A protective stoma was fashioned in all 44 patients (ileostomy n=41; colostomy n=3). Stoma closure was carried out after a median of 85 days (41-330 days). Using a standard protocol, anal-sphincter thickness [m. puborectalis, external anal sphincter (EAS) and internal anal (IAS) sphincter] was assessed by means of endoanal ultrasonography preoperatively, at the time of stoma closure, and every 3 months thereafter for 1 year. RESULTS: The diameter of the puborectal muscle decreased from a median preoperative value of 6.3 mm to 5.7 mm at the time of stoma closure (P=0.03). After 3 months, 6.2 mm was measured. This value remained stable for the complete follow-up period. Similar results were recorded for the EAS. The IAS thickness remained stable throughout the study period, measuring between 2.1 mm and 2.4 mm. CONCLUSION: Temporary stool deviation does lead to morphologic changes of the anal sphincter. While the smooth muscle remains unchanged, the striated counterpart undergoes atrophic transformation. However, after passage reconstruction, i.e., stoma closure, a rapid regeneration of the voluntary muscles is observed.

Aged↗
PubMed2001

T1 lesion load and cerebral atrophy as a marker for clinical progression in patients with multiple sclerosis. A prospective 18 months follow-up study.

We investigated the relationship between local tissue destruction, diffuse cerebral atrophy and clinical progression in patients with established multiple sclerosis (MS). Twenty-nine patients with MS (13 patients with relapsing--remitting and 16 with secondary progressive disease) were included in a prospective serial study. Cerebral volumes, T1 hypointense lesion volumes, T2 hyperintense lesion volumes at baseline and at 18 months follow-up, and the volume of monthly enhancing lesions from month 0 to month 9 were assessed on magnetic resonance imaging (MRI) brain scans using highly reproducible semi-automated quantitative techniques. The main outcome measures were the MRI parameters and disability on Kurtzkes' Expanded Disability Status Scale. There was a significant correlation between the change (increase) in T1 lesion volume and progressive cerebral atrophy, whereas no correlation between the T2 lesion volume and atrophy was seen over the same follow-up period. The change in T1 lesion volume correlated more strongly than did T2 lesion volume change with the change in disability. We conclude that hypointense abnormalities detected in T1-weighted brain scans and cerebral atrophy may be directly linked. Although one should bear in mind some potential for reversibility due to inflammatory, oedematous lesions, these MR measures are a useful marker of progressive tissue damage and clinical progression in established MS.

Adult↗
PubMed2001

[Pouch reconstruction after resection of the rectum].

Pouch reconstruction after resection of the rectum. Functional results after low anterior resection of the rectum and straight end-to-end coloanal anastomosis are often poor. Patients are frequently troubled by the so called "anterior resection syndrome" which comprises faecal incontinence, urge, frequency and fragmentation. To investigate the potential functional benefit of a coloanal pouch reconstruction we conducted a prospective study. Some 55 patients [29 men; median age 66,4 (30-85)] underwent low anterior resection of the rectum followed by coloanal J-pouch reconstruction. Pouch size was 5-7 cm, a temporary stoma was fashioned in 32 patients. Indications for the operation were: 1. rectal cancer: n = 51, 2. recurrent adenoma n = 2, 3. recto-vaginal fistula n = 1 and 4. severe non-specific proctitis n = 1. We observed 5 anastomotic leakages of which two patients required reoperation. A pelvic abscess was encountered in three patients as well as one pelvic haematoma. Micturition was impaired in five patients. To date 47 patients have completed 12 months follow-up after reversal of the ileostomy. Patients were seen at three-monthly intervals. Mean stool frequency/day was 3.9 after 3 and 2.6 after 12 months. After 3 months 38 patients (69 %) reported complete continence which increased to 83 % at 1 year. 18 Patients (33 %) complained of urge defaecation initially, which decreased to 14.5 % after 1 year. Fragmentation was observed in 40 % at 3 and and 22 % at 12 months, respectively. In conclusion, our initial experience with colonic J-pouch reconstruction shows good functional results.

Adult↗
PubMed2001

[Defecation properties after coloanal reconstruction in the pig model].

UNLABELLED: Defecation properties after coloanal reconstruction in the pig model. OBJECTIVE: Functional aspects after low anterior resection are of major interest. While patients with straight coloanal anastomoses may suffer from disabling stool frequency and incontinence, evacuation difficulties can be a problem in coloanal pouch anastomoses. The aim of the study was to investigate functional results by establishing a standardized defecation protocol after low anterior resection of the rectum in the pig model. METHOD: 24 adult Göttinger mini pigs were studied. They were randomly assigned to three groups: 8 animals served as control animals (group 1), the remaining 16 underwent low anterior resection with small colon-J-pouch (4-5 cm) reconstruction (n = 8) and large pouch design of 8-9 cm length (n = 8). The animals were investigated after 12 weeks postoperatively. Defecation properties we studied using a Ceruletide-induced defecography (0.3 microgram kgKG) with a 100 ml barium sulfate bolus, placed just above the anastomosis. RESULTS: Evacuation was significantly impaired in the large pouch (45 min.). However, the small pouches evacuated completely after 14 min. which was comparable to the unoperated controls (17.3 min.). CONCLUSION: Ceruletide-induced defecation reveals reproducible results in pigs. Evacualtion properties are highly depending upon the coloanal reconstruction. A small colon-J-pouch design reveals nearly physiologic results 3 months after surgery.

Anal Canal↗
PubMed2001

Defective mitochondrial oxidative phosphorylation in myopathies with tubular aggregates originating from sarcoplasmic reticulum.

Abnormalities of the sarcotubular system presenting as tubular aggregates (TAs) have been described in a variety of neuromuscular disorders. Here, we report on immunohistochemical and biochemical findings in 7 patients (2 familial and 5 sporadic cases) suffering from myopathies with TAs. In muscle biopsy specimens from 5 of the 7 patients, TAs were immunopositive for the ryanodine receptor (RYR 1) of the sarcoplasmic reticulum (SR), the SR Ca2+ pump (SERCA2-ATPase), and the intraluminal SR Ca2+ binding protein calsequestrin, indicating an SR origin of these aggregates. Furthermore, these 5 cases showed decreased respiratory chain enzyme activities (NADH:CoQ oxidoreductase. complex I and cytochrome c oxidase [COX], complex IV), while the remaining 2 patients exhibited normal values. Our findings indicate a functional link between mitochondrial dysfunction and the presence of TAs originating from the sarcoplasmic reticulum.

Adult↗
PubMed2000

Induction of cellular contractions in the human melanoma cell line SK-mel 28 after muscarinic cholinergic stimulation.

In a previous immunohistochemical study we observed muscarinic acetylcholine receptors in primary and metastatic human melanomas, which were not present in normal skin melanocytes. In the present study we demonstrated the endogenous expression of muscarinic receptors, of choline acetyltransferase and of cholinesterase activity in the human melanoma cell line SK-mel 28. We tested the effect of muscarinic agonists on cellular movements of the melanoma cells in a perfusion chamber by digital video time-lapse microscopy. Within 3 to 10 min after onset of muscarinic perfusion cell body contractions and retraction of cell processes of more than 5 micrometer occurred in about 30% of the melanoma cells. The effect disappeared after addition of atropine. The proportion of reacting cells corresponded to the endogenous expression of muscarinic receptors revealed by immunocytochemistry with the monoclonal antibody M35. The experiments indicate the presence of an autocrine muscarinic cholinergic system in the melanoma cells and demonstrate a direct link between muscarinic receptors and the contractile apparatus. Melanocytes are derived from neural crest cells that express cholinesterase activity and muscarinic receptors during their migratory phase in the embryo. Therefore, re-expression of the muscarinic cholinergic system in tumour cells may be involved in invasive growth.

Acetylcholine↗
PubMed2000

Comparison of anastomotic microcirculation in coloanal J-pouches versus straight and side-to-end coloanal reconstruction: an experimental study in the pig.

Several studies have shown a lower rate of anastomotic leakages in patients with coloanal J-pouch reconstruction than in those with straight coloanal anastomosis following anterior resection of the rectum. This study investigated whether this difference is due to a better anastomotic microcirculation. Thirty-two healthy, adult Göttinger mini-pigs underwent anterior rectal resection. They were subsequently randomized to following four groups (eight pigs per group): straight end-to-end, side-to-end, small pouch (4 cm), and large pouch (8 cm) coloanal anastomosis. Bowel perfusion was measured before and after vessel ligature at predefined locations using laser Doppler flowmetry. After completion of the anastomosis microcirculation was investigated 1 cm above, below, and directly at the anastomotic site. Following vessel ligature there was a 25% drop in blood flow. After completion of the anastomosis there was a further decrease of 25% in the distal segment, while no changes were observed above the anastomosis. There were no statistical differences either before or after completion of the anastomosis between the various groups. It is concluded that anastomotic blood flow does not depend on the type of coloanal reconstruction in healthy pigs.

Anastomosis, Surgical↗
PubMed2000

Amantadine influences cognitive processing in patients with multiple sclerosis.

We investigated the effect of amantadine on cognitive processing in patients with multiple sclerosis (MS) and fatigue with objective electrophysiological measures. Behavioral methods (Reaction Time, RT) and two different Event Related Potential (ERP) components measuring i) stimulus selection (Selection Negativity, SN) and ii) response selection (Lateralized Readiness Potential, LRP) were employed. Twenty-four patients with clinical definite MS (10 relapsing remitting and 14 secondary progressive) and confirmed fatigue in the past three months (Fatigue Severity Scale (FSS) > 4) were included. Patients were randomized in a double-blind, placebo-controlled cross-over design. We found a difference between the two treatments for ERP measures to stimuli with relevant colour starting at about 200 ms. This negativity had a higher amplitude during amantadine treatment regardless of treatment order. The RT did not differ significantly between the treated and untreated groups. Additional analysis indicated that patients with a disease duration of less than 7 years had a significant test position (practice effect), but no treatment effect, while patients with a longer MS duration showed no practice effect, but rather an improved reaction speed and increased ERP amplitude effects when treated with amantadine. The present findings suggest that amantadine exerts beneficial effects on early cognitive processes in patients with MS, but appears to be limited to subjects with a longer duration of the disease.

Adult↗
PubMed1999

Comparison of different J-pouches vs. straight and side-to-end coloanal anastomoses: experimental study in pigs.

PURPOSE: Functional results after low anterior resection with straight coloanal anastomosis are poor. Although certain functional aspects are improved with coloanal J-pouch anastomosis, evacuation difficulties are encountered in some of these patients. The aim of the study was to investigate the functional results of different reconstruction methods after low anterior resection in a standardized pig model. METHODS: Thirty-two adult Göttinger mini pigs were randomly assigned either to straight end-to-end (Group 1), side-to-end (Group 2), small (4-cm limb length) J-pouch (Group 3), or large (8-cm limb length) J-pouch (Group 4) coloanal anastomosis after low rectal excision. The animals were investigated 12 weeks after the operation by measuring neorectal compliance and ceruletide-induced defecation. Eight pigs without operation were used as controls (Group 5). RESULTS: Compliance was lowest in Groups 1 and 2, which were significantly different compared with both pouch designs and controls. Neorectal compliance of pigs with either small or large pouches did not differ significantly compared with one another or controls. Defecation was significantly impaired in pigs with a large pouch compared with all other groups. Pigs with side-to-end anastomoses had as rapid an evacuation as animals with straight coloanal reconstruction. CONCLUSION: Coloanal J-pouch reconstruction adequately restores reservoir capacity after low anterior resection of the rectum. From a functional point of view, side-to-end is not superior to straight coloanal anastomosis. Compared with small pouches, a large pouch design does not lead to better neorectal compliance in the pig model, whereas pouch evacuation seems to be considerably compromised.

Anal Canal↗
PubMed1999

Curative-intent radiation therapy in anal carcinoma: quality of life and sphincter function.

In 22 colostomy-free survivors of curative-intent radiation therapy or chemoradiation for anal carcinoma, measurement of the Gastrointestinal Quality of Life Index (GIQLI) revealed a mean 114 of a maximum 144 points, as compared to 121 in healthy volunteers (n = 150) and 113 in patients with benign anorectal diseases (n = 325). Sixteen patients underwent anorectal manometry to determine anal sphincter length (SL), resting pressure (RP), maximum squeeze pressure (MSP), rectal compliance (RC) and relaxation of the internal anal sphincter (RIAS). SL, RP and MSP were significantly lower in anal carcinoma patients than in healthy volunteers. Complete continence was detected in 56% of patients.

Adult↗
PubMed1999

Long-term results after 75 anastomoses in the upper extraperitoneal rectum with the biofragmentable anastomosis ring.

BACKGROUND: Anastomoses in the rectum have a higher risk for complications compared with other gastrointestinal regions. Stapling devices and sophisticated developments in surgical suture materials did not lead to a substantial decrease of local complications. The bioabsorbable anastomosis ring (BAR) is a new alternative technique for creating gastrointestinal anastomoses. Accordingly, the aim of this prospective study was to evaluate the postoperative course and long-term results of patients after anterior rectum resection using BAR. METHODS: From 1991 to 1996 75 BAR anastomoses were performed in the upper rectum at the Department of Surgery, University Hospital Würzburg. Thirty-eight patients suffered from malignant, 37 from benign disease. Mean age was 61.4 years with no relevant differences in the gender. Mean follow-up was 31 months (4-63 months). The clinical course was evaluated, a questionnaire completed and/or a 3-monthly reevaluation with endoscopy conducted. Mortality, anastomostic bleeding, leakage and development of anastomotic stenosis were evaluated. RESULTS: Sixty-seven patients could be reexamined. There was no postoperative mortality and no anastomotic bleeding. Six patients (8%) developed an anastomotic leakage, of whom 3 (4%) required reoperation. None of the patients revealed a detectable stenosis in the anastomotic region during follow-up. CONCLUSION: The BAR procedure is a safe and suitable anastomotic technique after anterior rectum resection.

Absorbable Implants↗
PubMed1999

Quantitative MRI in patients with clinically isolated syndromes suggestive of demyelination.

OBJECTIVE: To assess the long-term predictive value of quantitative lesion load measurement on brain MRIs in patients after a 10-year follow-up who presented initially with a clinically isolated syndrome of the optic nerve, brainstem, or spinal cord. BACKGROUND: Quantitative MRI measurement is being used in treatment trials as a surrogate marker in MS, but there is a lack of long-term MRI follow-up data in assessing the natural course of the disease from the earliest stages. METHODS: Using a semiautomated threshold technique, the total lesion volume (TLV), the course of the disease, and disability were assessed in 58 patients at onset and after 5 and 10 years. RESULTS: The TLV at presentation correlated significantly (r = 0.81, p = 0.0001) with the TLV and also with the Expanded Disability Status Scale (EDSS) score (r = 0.45, p = 0.001) at 10-year follow-up. In contrast there was no correlation of the TLV at 5 years with subsequent change in EDSS score over the next 5 years (r = 0.18, p = 0.12). The change in TLV over the first 5 years in patients who developed clinically definite MS (CDMS) differed significantly according to the type of disease course (relapsing-remitting with disability, secondary progressive, or benign) manifesting at 10-year follow-up. CONCLUSION: Quantification of changes detected by T2-weighted brain MRI at the earliest clinical stages is strongly predictive of the subsequent development of CDMS as well as the clinical course and level of disability 10 years later.

Adolescent↗
PubMed1999

[Arterial reconstruction in arteriopathic diabetic perforating ulcer--is it effective? Revascularization in diabetes mellitus and peripheral arterial occlusive disease].

OBJECTIVE: In the present study long-term patency and limb-salvage rates of femoro-distal bypasses were compared for patients suffering from PAOD stage III and IV with and without DM. METHODS: Between 1990 and 1994, some 192 femoro-crural bypass procedures were performed; 132 reconstructions were carried out on patients with PAOD, 60 bypasses on patients with PAOD and DM. The two groups did not differ significantly regarding age, gender and risk pattern. RESULTS: The comparison of the two groups showed a significant advantage for the diabetic patients regarding the limb-salvage rate. In both groups there was also a significant difference regarding patency in favour of the diabetics. CONCLUSION: Patients suffering from DM and PAOD profit from femoro-distal bypasses. An aggressive vasosurgical reconstructive therapy is indicated for these patients.

Aged↗
PubMed1999

[Open surgical therapy of constipation].

This paper reviews diagnostic criteria, indications, and selection criteria for surgical therapy in chronic constipation. Special emphasis is laid on surgical therapy of pelvic outlet obstruction. Colonic resection may be considered as last surgical resort in those few cases where conventional therapeutic measures have been exhausted and an extensive diagnostic protocol based on clearly defined criteria has been followed. This may offer a justifiable therapeutic alternative only in cases where highly symptomatic and refractory colonic inertia (slow transit constipation) is confirmed, and associated outlet obstruction has been excluded.

Chronic Disease↗