Biomedical subjects
Publications and source records attributed to R Siewert.
The endoscopic pneumatic dilation (EPD) procedure introduces an instrument which can be used in combination with fiberoptic-endoscopes types GIF-P and GIF-P2. The dilator is characterized by simple, easy, and gentle handling, even with extreme deviation at the gastro-esophageal junction. In daily clinical routine it has been shown to be effective in the treatment of achalasia.
In 36 patients with chronic duodenal ulcer disease LES-function before and after proximal-gastric vagotomy was examined manometrically and by determining pH-values in a prospective study. In addition, esophagus biopsies were taken 5 cm proximal of the cardia. 12 healthy volunteers served as controls. A direct effect of proximal-gastric vagotomy on LES-function could not be shown. On the contrary, in 38,9% of the patients examined, preoperatively proven esophagitis disappears nearly completely 12 months following proximal gastric vagotomy. This positive effect of vagotomy is to be interpreted as a beneficial effect on regurgitated intestinal juice, more so than an effect on cardia function itself.
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In patients with bleeding esophageal varices the main purpose of the treatment is to stop the bleeding at a justifiable risk. The so-called blocking procedures reach this purpose most consistently. We report the results on transmural variceal ligation plus fundoplication in 16 patients in whom the bleeding esophageal varices were not stopped by conservative means. 75% of these patients belonged to group B and C in Child's classification. Postoperative lethality was 18,7%, in all cases bleeding was stopped. These results favour trasmural varices ligation as an emergency procedure in bleeding esophageal varices.
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A case is demonstrated in which an indwelling intravenous catheter was pushed by mistake via V. subclavia and the right heart into the V. cava inf. There the catheter perforated the wall of the V. cava. The continued infusion induced a cystic retroperitoneal tumor. The puncture of this tumor was followed by a fistula that was misinterpreted as a fistula of the urinary tract.
Previous investigations show that calcium infusion stimulates gastrin output in healthy volunteers, whereas after antrectomy calcium does not cause any significant change of IRG levels. Both healthy volunteers and antrectomized patients (B II) show a continuous increase of LESP, reaching a maximum after 120 minutes. These results suggest a direct interaction of Ca++-ions and gastrointestinal smooth muscle cells.
Mechanical activity of isolated circular muscle strips from the lower oesophageal sphincter (LES), fundus, corpus and antrum of canine stomach was recorded. Nifedipine (10(-6) mol/l) selectively suppressed the phasic components of spontaneous, acetylcholine (ACh)- and noradrenaline (NA)-induced activity of gastric strips. The nifedipine-resistant tonic components of gastric strips were suppressed by nitroprusside sodium (NP) (10(-5) mol/l). LES strips exhibited only weak spontaneous activity. Their ACh-induced activation was nearly completely suppressed by nifedipine. Only NA was able to elicit a strong nifedipine-resistant activation which was, in contrast to the activation of fundus strips, not suppressed by NP.
Selective proximal vagotomy does not influence the function of the cardia. Only high intrathoracic vagotomy results in a decrease of LES pressure. Esophagitis, which is found in a high percentage of preoperative duodenal ulcer patients, heals after SPV.
The columnar epithelium lined esophagus is usually the result of a chronic reflux disease. In the literature one can find more and more references to a malignant transformation of this columnar epithelium. Our own observations of 14 patients with an adenocarcinoma in a columnar-lined esophagus support this suspicion. Because the adenocarcinoma of the esophagus has therapeutic consequences other than a squamous carcinoma of the esophagus, the surgery has to give attention to this malignant transformation of the columnar-lined esophagus.
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Reflux esophagitis is a benign disease. Therefore, therapeutic indications are of special significance. Surgery is undisputed in cases of failure of conservative therapy. For the first time reliable data are available on the effectiveness and on the barriers of conservative therapy, because of initial results from double blind studies. According to these results, healing of reflux esophagitis of grades I and II can be expected under conservative therapy. However, most of the patients in grades III to IV, resisted conservative therapy, so an operation is indicated.
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Five different disorders of motility of the pyloric region may be distinguished if direction and velocity of chyme passing through the pylorus are taken into account: 1. Accelerated emptying of food and overacidification of the bulbus duodeni: 2. Bolus emptying of the stomach and rapid increasing hyperosmolarity in the small intestine: 3. Delayed emptying of the stomach and gastric retention: 4. Duodeno-gastric reflux and inflammatory lesions of the gastric mucosa: 5. Other disorders causing pain. Gastric disroders cannot yet be classified on the basis of abnormal motility patterns. It is well known, that the gastric and duodenal motility are regulated by two separate pacemakers located in the distal corpus area and in the bulbus duodeni. Thus it may be speculated that distrubed motility patterns may be due to abnormal pacemaker function.
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