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Biomedical subjects

R Siewert

Publications and source records attributed to R Siewert.

At least 55 records · Page 3Linked to original sources
PubMed1978

[Clinical significance of hiatal hernia].

A careful clinical investigation of 245 patients with hiatus hernia was performed. (History and physical examination, x-ray tests, oesophago-gastroscopy with biopsies, 3-point-manometry, rapid pull-through manometry with pentagastrintest). Classification of hiatus hernia was performed by x-ray test. (222 axial hiatus hernia, 14 mixed hiatus hernia, 9 paraoesophageal hiatus hernia) 3-point-manometry and rapid pull-through manometry with Pg-test were used to differentiate the function of the cardia. In spite of a strong selection in 84 out of 245 patients examined in our hospital, a sufficient cardia could be seen. 161 cases showed a gastro-oesophageal reflux which has been in accordance with a decompensated reflux disease in 97 patients. Solely in these 97 patients an operative correction of the gastro-oesophageal reflux seemed convenient. 84 patients showed a considerable variability of oesophageal disorders. In a final correlation between endoscopy, manometry and x-ray tests our opinion was confirmed that hiatus hernia must not lead inevitably to an insufficiency of the cardia. In the above investigations it could be shown that any therapeutic proceeding in the treatment of hiatus hernia first needs a careful analysis of the cardiac and oesophageal activity and second requires a careful indication for the surgical treatment of hiatus hernia.

Cardia↗
PubMed1978

Effect of intraduodenal peptone on the lower esophageal sphincter pressure in the dog.

The role of the duodenum in the regulation of the lower esophageal sphincter pressure (LESP) was investigated in 4 unrestrained dogs equipped with a chronic Komarov type esophagostomy, a cutaneous duodenal fistula, a gastrojejunostomy, and a Y anastomosis between the distal end of the duodenum and the midjejunum. Installation of NaCl solution into the duodenum or into the stomach did not effect LESP during the following 60-min observation period. Peptone instillation into the duodenum or into the stomach produced a sustained elevation LESP. The rise of LESP was significantly greater after duodenal than after gastric instillation. Duodenal peptone did not raise serum gastrin. It is concluded that the duodenum may be an important regulator of LESP in the dog and that this effect is not mediated by circulating gastrin.

Animals↗
PubMed1978

[Cardia function following Billroth I and Billroth II gastrectomy (studies on the significance of duodenal passage for cardia function)].

To clarify whether the duodenum is important to the regulation of cardia function, patients with B-I and B-II resections were investigated manometrically. A test meal can stimulate the LES in patients with a B-I resection almost to the same extent as that in healthy test persons. Symptom-free patients with the distal stomach resection and gastrojejunostomy (B-II) do not show this pressure reaction. Therefore, the duodenal passage could be of importance to cardia function. In patients with a transformation operation of B-II in B-I, because of postgastrectomy symptoms a stimulation of the LES cannot be achieved either before or after the transformation operation. We cannot presently clarify the type of the cardia regulation since the IRG levels measured do not explain this phenomenon.

Adult↗
PubMed1977

[The effect of antrectomy or total gastrectomy on calcium-induced gastrin secretion and gastrin release in man (author's transl)].

The effect of induced hypercalcemia on serum gastrin concentrations, measured by radioimmunoassay, and gastric acid secretion was studied in 20 healthy subjects, 8 patients after antrectomy and gastroduodenostomy (Billroth I), 12 patients after antrectomy and gastrojejunostomy (Billroth II) and in 9 patients after total gastrectomy and esophagojejunostomy. In normal man calcium stimulates gastric secretion and gastrin release. After antrectomy gastric secretion is still stimulated by calcium without changing serum gastrin levels. After total gastrectomy basal serum gastrin concentration is further reduced; calcium does not liberate gastrin. These results show that calcium-induced gastric secretion is caused by direct action at the parietal cell level besides the gastrin release from the antrum. In man, extra antral gastrin cannot be released by induced hypercalcemia.

Adult↗
PubMed1977

[Surgical treatment of the mammary carcinoma according to stage (author's transl)].

Improvement of the results of treatment was achieved only when an increased number of patients were diagnosed in stage I. The prerequisite for limitation of radical surgery is histomorphologic classification of the stages. The central axillary group of lymph nodes appears to be representative of lymph node involvement. Differentiated methods of operations range from local excision to mastectomy in case of precancer. In histologic stage I, modified radical mastectomy; is the treatment of choices; operations with further limitations are recommended only within the scope of controlled studies. In stage II, the classical ablation is still the safest procedure.

Axilla↗
PubMed1977

[Peptic ulcer: indication for surgical treatment (author's transl)].

Treatment of duodenal ulcer has been improved by proxmial gastric vagotomy and the H2 antagonist cimetidine. These new types of treatment may also be useful in gastric ulcer. Thus, new guidelines for the elective surgery and the treatment of bleeding ulcer are needed. These guidelines are obtained by a compromise between the conflicting viewpoints of a surgeon and an internist.

Adult↗
PubMed1977

Effect of cimetidine on lower esophageal sphincter pressure, intragastric pH and serum levels of immunoreactive gastrin in man.

The influence of cimetidine on the lower esophageal sphincter, the intragastric pH and the serum levels of immunoreactive gastrin was investigated in eight volunteers and compared with a control group. After oral application of 400 mg cimetidine, the intragastric pH rose from 1.7 +/- 0.13 to 6.2 +/- 0.4 and the lower esophageal sphincter pressure increased slightly but significantly from 15.6 +/- 1.1 to 22.7 +/- 1.8 mm Hg after 20 min and to 25.8 +/- 2.0 after 30 min, respectively. At the same time the serum immunoreactive gastrin levels did not change. A direct effect of cimetinidine on the lower esophageal sphincter or an indirect effect via gastric alkalinization is discussed.

Administration, Oral↗
PubMed1977

The relationship between serum IRG levels and LES Pressure under various conditions.

In investigations with various groups of patients there was no correlation between fasting serum IRG levels and LES pressures in individual subjects with undisturbed for disturbed sphincters. After food ingestion a short phase of LES pressure increase (from 13.5 +/- 1.5 to 21.7 +/- 3.8 mm Hg) could be observed. This peak occurs during the phase of rise in gastrin level, but there was no correlation between IRG levels and LES pressure in individual cases. In patients with gastroesophageal reflux we can demonstrate a diminished release of gastrin after a test meal, but there was also a diminished capacity of the LES. In conclusion, in this investigation it has not been possible to show a clear connection in humans between serum IRG and LES function.

Esophageal Achalasia↗
PubMed1977

[20 years in the management of reflux disease using fundoplication].

During the past twenty years fundoplication has found widespread propagation. Due to its effectiveness it is today the most often applied operative procedure of reflux-preventing surgery. As such the method must be reserved for clearly demonstrated reflux disease and its organic complications. False indication and incorrect technique have burdened results of such operations with unnecessary complications. The steps to a successful surgical reconstruction of the cardia are thus shown. In the future, the results of this surgical method will have to be improved more by correct indication instead of changing the surgical technique.

Esophagitis, Peptic↗
PubMed1977

[The telescope phenomenon. A complication possibility following fundoplication].

On the basis of four cases from our own clinic and three outside cases, we describe a so-called, "telescope phenomenon". This involves a specific complication that may arise after fundoplication. The characteristic of this postoperative complication is the slipping down of the fundus cuff, accompanied by a telescopic pushing upwards of the cardia. Recurrent reflux and occasionally new manifestations of dysphagia are the clinical results of this. This paper describes the diagnostic procedure and therapy of the telescope phenomenon.

Adult↗
PubMed1977

[Clinical and experimental studies on the efficiency of nifedipine on smooth muscle strips of the esophagus (author's transl)].

Based on in vivo studies on isolated muscle strips of the LES and on manometric in vivo studies on 8 mongrel dogs, 6 healthy volunteers, 6 patients with achalasia and 3 subjects with diffuse esophageal spasm we could demonstrate that nifedipine causes a long-lasting relaxation of smooth muscle, the esophagus and LES. In 8 dogs resting pressure at the LES was decreased by 20 mg nifedipine from 18.5 +/- 1.8 mm Hg to 8.2 +/- 0.9 mm Hg. This pressure decrease could not be reversed by pentagastrin stimulation (3.0 microgram/kg KG PG). The resting pressure in LES was decreased from 26.8 +/- 3.8 mm Hg to 16.4 +/- 2.1 mm Hg in healthy volunteers and from 45.5 +/- 2.6 mm Hg to 14.5 +/- 0.4 mm Hg in patients with achalasia. In 3 patients with diffuse esophageal spasm nifedipine (20 mg) caused a mean decrease of 38% of the contraction amplitude. Further clinical studies have to be done to clarify if the spasmolysis by nifedipine may be important in the treatment of spastic or hypertonic motility disorders of the LES and the esophagus.

Adult↗
PubMed1977

[The role of the duodenum in the regulation of the lower esophagus sphincter].

Instillation of a 20% peptone solution into the isolated duodenum causes a significant increase of LES-pressure in the dog. No comparable increase of LES-pressure after instillation of a 0.9% saline solution into the duodenum or of 20% peptone solution into the stomach is observed. As shown in this investigation, it is possible that the duodenum regulates the LES-pressure in the dog.

Animals↗
PubMed1977

[Manometry and gastro-esophageal closure mechanism. An attempt at evaluation (author's transl)].

The registration of resting pressures and motility activity has considerably increased our knowledge of the normal functioning of the esophagus. We have not jet solved all the methodological problems of manometry; however perfusion manometry, which is used today, has enabled us to make an exact cassification of functional disorders and adequate therapy. An understanding of the methodological problems involved is necessary for the correct use of the manometric method and the correct interpretation of its results. This precondition has not always been observed, especially in discussion of the gastro-esophageal closure mechanism, and has thu given rie to much confusion. An attempt at a critical evaluation should be the basis for future discussion.

Cardia↗