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Biomedical subjects

R Pointner

Publications and source records attributed to R Pointner.

At least 55 records · Page 3Linked to original sources
PubMed1996

Laparoscopic technique of proximal selective vagotomy.

Proximal selective vagotomy (PSV) is an effective, definitive therapy for peptic ulcer disease of the duodenum. Long-term studies have shown that ulcer recurrence occurs in less than 10% of patients if the operation is performed by an experienced surgeon. Since PSV does not influence gastric emptying, side effects such as diarrhea, gastric stasis or the dumping syndrome are rare. Due to this favorable experience, PSV is our preferred technique for the laparoscopic approach to peptic ulcer disease. We have performed this operation in 13 patients. Indications were chronic duodenal ulceration unresponsive to medical therapy, chronic duodenal ulceration combined with reflux esophagitis, and reflux esophagitis due to gastric acid hypersecretion. In patients with reflux esophagitis PSV was performed in addition to an antireflux procedure. Laparoscopic PSV can be performed more accurately than the open procedure since it allows for better visualization with less possibility of missing small vagal connections to the parietal cells such as the 'criminal nerve'. The median duration of operation was 3 hours. There were no serious peri- or postoperative complications. The median time of postoperative hospital stay was 3 days. During the median follow-up of 27 months no recurrence of duodenal or esophageal ulceration was encountered and none of the patients complained of epigastric pain, diarrhea or dumping symptoms.

Adult↗
PubMed1994

Gastric remnant cancer has a better prognosis than primary gastric cancer.

OBJECTIVE: To study the prognosis of gastric remnant cancer following radical resection (group 1) compared with that of primary gastric cancer of the upper third of the stomach following radical resection (group 2). DESIGN: Cohort study with a 5-year follow-up. SETTING: A university hospital in Austria. PATIENTS: Group 1 consisted of 43 patients, and group 2, of 61. Postoperative deaths and deaths during the follow-up period that were not related to gastric cancer were excluded. Fifteen patients in group 1 (34.9%) presented with stage I cancer; 10 (23.3%), stage II; 13 (30.2%), stage III; and five (11.6%), stage IV. Twenty patients in group 2 (32.8%) presented with stage I cancer; 12 (19.7%), stage II; 15 (24.6%), stage III; and 14 (22.9%), stage IV (Union Internationale Contre le Cancer staging classification, 1987). MAIN OUTCOME MEASURES: Overall and stage-related 5-year survival rates. RESULTS: The overall 5-year survival rate was 53.5% in group 1 and 32.8% in group 2 (P < .05). The stage-related 5-year survival rate in group 1 was 100% for stage I and 80% for stage II. In group 2, the stage-related 5-year survival rate was 65% for stage I and 25% for stage II (both, P < .01). No significant difference was noted for stages III and IV. CONCLUSIONS: The prognosis of cancer of the gastric remnant presenting as stage I or II is good and is significantly better than that of the equivalent stages of primary cancer of the upper third of the stomach.

Adolescent↗
PubMed1994

Bone disorders following total gastrectomy.

Bone disorders following gastrectomy were studied by measuring absolute and relative bone mineral density of the Wards triangle, serum 1,25-(OH)2-D, alkaline phosphatase, and total serum calcium. The subjects were 20 males who had undergone total gastrectomy not more than three months previously (group A1). Seventeen of these patients were reviewed three years later (group A2). Absolute and relative bone density were significantly lower in group A2 than in A1 (0.52 +/- 0.011 g/cm2 versus 0.6 +/- 0.014 g/cm2, P < 0.01 and 85.5 +/- 1.4% age-matched control versus 95 +/- 1.3%, P < 0.01). 1,25-(OH)2-D was significantly lower in group A2 than in group A1 (14.3 +/- 0.97 pg/ml versus 20.6 +/- 1.02 pg/ml, P < 0.01). There was no difference in alkaline phosphatase and calcium serum concentration. The mean weight loss was 6.26 +/- 0.57% over the follow-up period, and weight loss correlated with absolute and relative bone density (r = -0.74, P < 0.01). There was a positive correlation between 1,25-(OH)2-D and absolute or relative bone density (r = 0.67, r = 0.62 and P < 0.01). These data suggest that bone density decrease has already occurred three years after total gastrectomy and is positively correlated to 1,25-(OH)2-D deficiency. As no differences in serum alkaline phosphatase and serum calcium concentration were found, these factors are of little value for the early detection of postgastrectomy bone disorders, whereas weight loss is a valuable screening parameter.

Aged↗
PubMed1994

Lymphangitis carcinomatosis of the lesser omentum: a prognostic factor in gastric cancer.

A series of 126 patients with gastric cancer who underwent radical gastrectomy with systemic lymph node dissection revealed 9 patients who survived for a median time of only 3 months. Of these 9 patients, 4 were classified by the UICC system as stage II and 5 as stage III, all of whom had lymphangitis carcinomatosis of the lesser omentum. These data suggest that although lymphangitis carcinomatosis of the lesser omentum is an uncommon finding, if it is present, curative surgery is impossible and an operation should therefore be limited to tumor palliation.

Adult↗
PubMed1994

Traumatic bilhemia.

BACKGROUND: Retrospective analysis was done of three cases with severe liver trauma and excessive serum bilirubin levels caused by a traumatic biliovenous fistula. The literature is reviewed. METHODS: Diagnostic measures included laboratory findings, computed tomography, ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The biliovenous fistula was detected by ERCP in two cases. In one case a left hemihepatectomy was carried out, and the patient was cured. The other patient received drainage of a huge necrotic cavity in the center of the liver. Ten months later the patient underwent reoperation, and left hepatic resection was performed. The patient died of liver function failure on postoperative day 7. In the third case the fistula subsided spontaneously. CONCLUSIONS: An excessively high serum level of direct bilirubin and only moderately elevated liver enzymes indicate bilhemia in trauma patients. ERCP is most reliable in localizing the fistula; computed tomography/ultrasonography are valuable in detecting the extension and localization of the parenchymal destruction. Conservative therapy is justified if the patient is in good condition or if the localization of the fistula is unclear. Spontaneous closure of the fistula may occur. Surgical treatment options are partial liver resection and suture of the fistula and T-tube drainage of the common bile duct and drainage of the rupture site.

Adolescent↗
PubMed1992

Primary squamous cell carcinoma of the stomach in a seventeen-year-old boy.

Primary squamous cell carcinoma (SCC) of the stomach is extremely rare and thought to arise from ectopic squamous epithelium, which in turn could either result from the squamous metaplasia of the gastric mucosa or be congenital in origin. We report herein a case of SCC of the stomach in a 17-year-old male, who died 1 year after undergoing a gastrectomy. To our knowledge, this is the youngest case of primary SCC of the stomach reported in the literature. Further speculative possibilities of the development of primary gastric SCC are discussed following the presentation of this case.

Adolescent↗
PubMed1992

Treatment of calculi of the common bile duct.

Endoscopic sphincterotomy (EST) is regarded as an alternative therapeutic approach to the surgical treatment of choledocholithiasis. To clarify the indication for each of these two methods, a prospective study has been performed comparing patients with calculi of the common bile duct who had undergone endoscopic or surgical treatment. Mortality, morbidity and stone clearance were used as criteria for the evaluation of the dependence of age on results achieved by the two modalities. Of 306 patients with choledocholithiasis, 199 underwent surgical exploration of the duct and 107 underwent endoscopic sphincterotomy. Patients who were more than 60 years of age and had previously undergone cholecystectomy underwent endoscopic sphincterotomy. All other patients had surgical treatment. There were no significant differences among the two groups with regard to mortality rates. The incidence of relevant complications as well as the incidence of surgical revisions related to postoperative complications in the operation group was, however, significantly higher (p less than 0.05). In contrast with this, the incidence of retained stones was significantly lower (p less than 0.01) in the group that underwent surgical treatment (2.5 percent) than in the group that had endoscopy (11.2 percent). When assessing the results in terms of stone clearance, complications and mortality rates, findings seem to indicate that a safe limit for the application of surgical treatment would be 60 years of age, whereas older patients should be primarily considered as candidates for EST.

Age Factors↗
PubMed1989

[Endoscopic sclerotherapy of bleeding Mallory-Weiss mucosal tear].

Based on a review of 66 patients with the Mallory-Weiss syndrome, the problems of diagnosis and treatment in general, and the application of sclerotherapy in particular in patients with bleeding tears is discussed. At emergency endoscopy 32 patients (48.4%) had an acute bleeding episode which could be stopped by sclerotherapy in 26 of 27 cases. The importance of control endoscopy after 48 hours and its influence on prognosis are emphasized.

Adolescent↗
PubMed1989

[Tumor markers in the upper intestinal tract--stomach and pancreas].

Expectations of early diagnosis of carcinoma of the stomach and pancreas by using the tumour markers CEA and CA 19-9 have been disappointed. Although the sensitivity of CA 19-9 for pancreatic cancer is high, its field of application for screening is not efficient due to poor specificity of the marker. CEA and CA 19-9 are of great importance in the follow-up of pancreatic cancer. Results of tests of CEA and CA 19-9 in 100 patients with gastric cancer and 50 patients suffering from pancreatic cancer are reported.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1989

Colonoscopic treatment of sigmoid volvulus.

Sigmoid volvulus commonly presents with signs of bowel obstruction. In the absence of an exact preoperative diagnosis, these patients have to undergo urgent surgery. We report a case of sigmoid volvulus diagnosed radiologically and managed by endoscopic derotation. When the cause of the obstruction is known to be due to sigmoid volvulus, surgery can be avoided by careful endoscopic derotation of the sigmoid colon.

Adult↗
PubMed1989

"Reversible gastric banding" in surgical treatment of morbid obesity--results of animal experiments.

The basic principle of "reversible gastric banding" as a new surgical approach to morbid obesity treatment is the creation of a small fundus reservoir using a silicone cuff which is coiled around the stomach close to the cardia. The extent of obstruction corresponds to the amount of liquid in the cuff which can be varied by puncture of a valve implanted in the subcutis. The reversibility of gastric obstruction is the great advantage of this method as compared to vertical banded gastroplasty or gastric bypass. We studied this method in animal experiments using seven "Göttinger Minipigs". In two animals the objectives of the study were reached, the observed complications, mostly caused by the nature of the test animal, are analyzed and discussed. To our knowledge, this is the first report in the literature on animal experiments in bariatric surgery.

Animals↗
PubMed1989

Endoscopic removal of a pedunculated bronchial lipoma by means of the hot snare.

The complete endoscopic removal by means of the hot snare of a pedunculated bronchial lipoma with a carcinoma in situ in its covering bronchial epithelium is reported. To our knowledge, the endoscopic removal of peripheral polypoid bronchial lesions has not been reported to date. The advantage of this technique lies in its ability to permit an exact histologic examination of the lesion, in contrast to laser vaporisation.

Aged↗