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W Feil

Publications and source records attributed to W Feil.

54 records · Page 3Linked to original sources
PubMed1988

Acid stimulated alkaline secretion in the rabbit duodenum is passive and correlates with mucosal damage.

Low luminal acid concentrations stimulate alkaline secretion (AS) by the duodenal mucosa. We investigated acid stimulated alkaline secretion by proximal rabbit duodenal mucosa in an Ussing-chamber under different luminal acid concentrations and its relation to mucosal damage. Luminal alkalinisation and potential difference (PD) were measured and mucosal damage was investigated histologically. Luminal acid caused an increase of alkaline secretion over baseline (0.95 +/- 0.19 mu Eq/cm2/10 min; n = 55): 0.1 mmol: 7%, 1 mmol/l: 17%, 5 mmol/l: 22%, 10 mmol/l: 33%, 20 mmol/l: 34%, 50 mmol: 39%, 100 mmol/l: 27%. At acid concentrations of 10 mmol/l and above the PD fell from 2.0 +/- 1.0 mV to zero. Histology showed [H+]-dependent mucosal damage ranging from villus tip lesions to deep mucosal injury. Stimulation of alkaline secretion was not specific for acid. Ethanol (14%) stimulated alkaline secretion by 26%, and 28% ethanol by 40% over baseline. Ouabain and/or anoxia sensitive (active) alkaline secretion constituted 80% and 100% respectively of basal alkaline secretion. After exposure to various luminal acid concentrations passive diffusion (sensitive only to removal of nutrient HCO3-) was solely responsible for the rise in alkaline secretion. Only after 14% ethanol a small rise in ouabain and/or anoxia sensitive HCO3- transport was observed. Under the conditions of this study stimulation of duodenal alkaline secretion is not specific for luminal acid, but occurs also with luminal ethanol; both agents stimulate alkaline secretion depending on their concentration. In this model passive diffusion of HCO3- associated with increasing mucosal damage is the major component of the rise in alkaline secretion.

Animals↗
PubMed1988

[Hemodynamic and metabolic changes during orthotopic liver transplantation].

Hemodynamic and metabolic profiles were obtained on 48 adult patients (mean age 46 years) undergoing orthotopic liver transplantation without using a bypass technique during the anhepatic period. Baseline measurements after induction of anesthesia (A) revealed a high-output circulatory state. During hepatic dissection (B, preclamping control), mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAP), and elevated cardiac index (CI) were well maintained. Preoperative plasma exchange with fresh frozen plasma in the presence of severe coagulation defects and liberal use of platelet concentrates limited the need for massive blood transfusion, and thus contributed to stable hemodynamics during this stage. Significant cardiovascular changes occurred immediately after clamping of the inferior vena cava and the portal vein (C): there was a marked fall in MAP (-30%), MPAP (-45%), PCWP (-48%), RAP (-40%), and CI (-60%) reflecting the hemodynamic adaptation to the impeded venous return. At the end of the anhepatic period (D), MAP (-21%), MPAP (-38%), PCWP (-39%), RAP (-24%), and CI (-56%) were persistently lowered because no attempts were made to attenuate the clamping response by vigorous volume expansion or infusion of inotropic drugs. The reduction in oxygen availability index (O2AVI) was compensated by enhanced oxygen extraction. Oxygen consumption index (VO2I) fell secondary to the removal of the liver and the decrease in body temperature (BT). Potassium levels and acid-base balance were well controlled; no hypoglycemic episode was observed during the anhepatic period.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1988

[Secondary achalasia caused by diffuse infiltrating cardial cancer].

Malignant tumors, especially gastric adenocarcinomas infiltrating into the submucosa of the esophagus, can result in a clinical syndrome termed secondary or pseudo-achalasia that mimicks idiopathic primary achalasia. History, symptoms, radiology, esophago-gastroscopy with biopsy, and esophageal manometry do not discriminate secondary from primary achalasia at initial evaluation. The difficulty in establishing the diagnosis is demonstrated on the case of a 57-year old man presenting with dysphagia, vomiting, and weight loss. Fluoroscopically, the esophagus was moderately dilated and bird-beaked. The patient underwent two gastroesophagoscopies, in the second of which the endoscope could not be passed through the esophagogastric junction. Esophageal manometry revealed an only partial relaxation of the lower esophageal sphincter upon swallowing and nonpropulsive, repetitive contractions in the esophageal body, compatible with the diagnosis "vigorous achalasia". After two mechanic dilatations, a myotomy of the sphincter seemed indicated. At operation, a cardiac carcinoma infiltrating submucosally into the esophagus was found. The recognition of secondary achalasia is difficult, and signs such as older age, brief duration of symptoms, marked weight loss and the presence of vigorous achalasia, relatively rare in primary achalasia, are unspecific. Hence, in all instances in which secondary achalasia cannot be ruled out, it seems advisable to perform an explorative laparotomy with eventual sphinctermyotomy as primary therapeutic intervention instead of a mechanic dilatation, which potentially further obscures the underlying disease. To enable the recognition of undetected secondary achalasia, all patients with achalasia should be followed up thoroughly.

Adenocarcinoma↗
PubMed1987

[Significance of alkali secretion in acid tolerance of the rabbit duodenum].

Different rates of alkaline secretion and their effect on acid tolerance were investigated in segments of proximal duodenum of anaesthetized New Zealand white rabbits in situ. Metabolic alkalosis and glucagon led to a significant increase in alkaline secretion, while metabolic acidosis, vasopressin and furosemide significantly reduced alkaline secretion. Mucosal blood flow was significantly increased by glucagon and decreased by vasopressin. Alkaline secretion after an acid challenge was significantly higher than preacid secretion in animals with metabolic alkalosis, glucagon and NaCl, whereas vasopressin reduced alkaline secretion significantly. No significant change was observed during treatment with furosemide or metabolic acidosis. After perfusion with acid, 51.8% of the villi showed superficial damage (stage 1) under control conditions. Damage was significantly reduced after administration of bicarbonate or glucagon, while NH4Cl, vasopressin or furosemide increased damage both quantitatively and qualitatively. There was a direct linear correlation between the degree of damage and alkaline secretion. The proximal duodenum showed considerably less damage than the distal segment. We conclude that a decrease in alkaline secretion is associated with a reduced tolerance of duodenal mucosa to luminal acid, whereas stimulation of alkaline secretion improves mucosal protection. These results support the hypothesis that alkaline secretion is an important factor in the protection of the duodenum against luminal acid.

Acid-Base Equilibrium↗
PubMed1987

[Value of consistent after care in stomach cancer].

This study analyses the efficacy of a consistent, strict follow-up programme in the management of patients with gastric cancer. Between 1978 and 1986 671 patients were treated, of whom 361 (54%) had a radical operation. The data were fed into an electronic data base and patients were invited to attend the follow-up investigations. The drop-out rate was 21%. Recurrence was detected in 177 cases, 25% in the liver, 25% as carcinosis, 21% in lymph nodes, 15% locally and 14% in other localizations. 78% of the recurrences were seen two years postoperatively and 27% were asymptomatic; 10% underwent radical operation, 27% palliative operation and 63% conservative treatment. Survival rates after 3 and 5 years were 73% and 62% in patients without recurrence and 21% and 8% with recurrence, respectively (p = 0.0 Breslow and Mantel test). The survival rate 2 years after treatment of recurrence was 37% after radical surgery and 0% after palliative operations or conservative treatment (p less than 0.06 Breslow and p less than 0.002 Mantel test). Furthermore, a tight follow-up programme enables control of surgical quality and accurate follow-up during clinical trials, whilst the opportunity to advise patients after operation is an important aspect.

Adult↗
PubMed1987

[Non-Hodgkin's lymphoma of the stomach: surgical therapy and prognosis].

This study reports 43 patients (male: n = 17, female: n = 26) with non-Hodgkin's lymphoma of the stomach, who underwent surgery between 1. January 1977 and 31. December 1986. The main clinical symptoms were abdominal pain, weight loss and vomiting. Symptoms preceded diagnosis by 13 weeks. Barium meal and endoscopy were useful diagnostic procedures. The biopsy specimens indicated malignancy in 80% of cases. Operations performed were: total gastrectomy (n = 18), distal resection (B I: n = 4, B II: n = 14), partial duodenopancreatectomy (n = 3), proximal gastric resection (n = 1), local excision (n = 1) and explorative laparotomy (n = 2). Perioperative mortality was 0%. Peritonitis occurred in 1 patient due to leakage of the duodenal stump. According to the Ann-Arbor system we found stage I in 19, stage II in 10 and stage III in 14 cases. The histological type according to the Working Formulation showed low grade of malignancy in 15 and high grade of malignancy in 28 patients. All patients underwent postoperative chemotherapy and/or radiotherapy with respect to tumour staging and morphology. 24 patients are alive without relapse, 16 patients died intercurrently. The data were collected retrospectively and analysed by means of Kaplan-Meier survival functions. For comparisons we used the Breslow and the Mantel test. We investigated the prognostic significance of: sex, clinical symptoms, localisation of the tumour, type and radicality of operation, lymphadenectomy, splenectomy, splenic infiltration, tumour size and depth of infiltration, staging and grading. The 2-year survival rate was 82%, the 5-year rate was 55%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Repair of rabbit duodenal mucosa after acid injury in vivo and in vitro.

Epithelial repair after luminal acid exposure was studied in the rabbit duodenum in vivo and in vitro. Hydrochloric acid (200 mM, 30 min in vivo; 10 mM, 10 min in vitro) caused a uniform damage of the mucosa confined to the villi. After demarcation and detachment of the necrotic tissue the defect was bridged by the remaining viable epithelial cells, resulting in a reduction of villus height. This process of mucosal repair proceeded continuously, so that 9 h after acid damage only 33% of villi in the proximal duodenum and 41% in the distal duodenum remained not fully restored, at both luminal pH 7 and luminal pH 3. The difference is due to the higher acid susceptibility of the distal duodenum. In vitro, most of the mucosal surface was reconstituted 5 h after acid injury, at both luminal pH 7.4 and luminal pH 3. The potential difference declined and reversed after mucosal damage; restitution to original values was only observed at luminal pH 7 in vivo and luminal pH 7.4 in vitro.

Animals↗
PubMed1987

The effect of acid perfusion on mucosal blood flow and intramural pH of rabbit duodenum.

To evaluate the role of blood flow for acid tolerance of the duodenal mucosa, we perfused the duodenums of anesthetized rabbits with different concentrations of hydrochloric acid (HCl). Acid perfusion stimulated blood flow to the duodenal wall in a concentration-dependent fashion up to 80 mmol/L HCl (0 mmol/L; 0.44 +/- 0.05, 10 mmol/L; 0.84 +/- 0.14, 50 mmol/L; 1.44 +/- 0.11, 80 mmol/L; 2.03 +/- 0.12, 100 mmol/L; 1.82 +/- 0.07 ml/gm/min X +/- SEM). The pH in the lamina propria of the mucosa, which was measured with antimony microelectrodes was not changed in experiments during perfusion with 50 and with 80 mmol/L HCl in normotension. Acidosis in the lamina propria could be demonstrated only when the duodenum was perfused with 100 and with 80 mmol/L HCl combined with hemorrhagic hypotension. Damage to the mucosa, which developed after 30 and 60 minutes of acid perfusion, also showed a H+-dependent pattern. Reduction of blood flow by hemorrhagic hypotension aggravated the morphologic damage. We conclude that luminal acid stimulates blood flow in the duodenum. The decrease in blood flow induced by hypotension results in a greater susceptibility to mucosal damage.

Animals↗
PubMed1987

Alkaline secretion. A protective mechanism against acid injury in rabbit duodenum.

The role of alkaline secretion in the protection against acid-induced (50 mM HCl) damage was investigated in the perfused rabbit duodenum. Basal alkaline secretion was 3.86 +/- 0.23 mu Eq/cm2 . 10 min (pH-stat method). Perfusion with HCl increased alkaline secretion to 4.39 +/- 0.17 mu Eq/cm2 . 10 min and led to superficial damage of 51.8% of the villi. Intravenous treatment with NaHCO3 and glucagon increased alkaline secretion (+25% and +37%, respectively) and decreased damage (-27.7% and -25.3%, respectively), whereas mucosal blood flow as assessed by radioactive microspheres was stimulated only by glucagon. Intravenous treatment with NH4Cl, vasopressin, and furosemide decreased alkaline secretion (-31%, -52%, and -50%, respectively) and led to increased damage (+18.5%, +19.3%, and +19.6% superficial and 30%-50% deep lesions), and mucosal blood flow was decreased (vasopressin) or unchanged. There was a direct linear relationship (r = 0.88, y = 103-15.8x) between the degree of damage and alkaline secretion. These results support the hypothesis that duodenal alkaline secretion is indeed a protective factor against acid damage.

Animals↗
PubMed1986

[Consequences of after-care in colorectal cancer].

Results of a computer supported follow-up-program on patients with colorectal cancer are presented. Between 1978 and 1985 1024 patients underwent these program, the drop-out-rate was 18%. 231 recurrences in 137 patients were discovered (40% local recurrence, 30% liver metastases and 30% others). 54% of patients with local recurrence and 43% with liver metastases were free of symptoms. Radical surgery was performed in 47% of local recurrences and in 24% of liver metastases. The three year survival rate after radical surgery for recurrence amounted to 28% for local recurrences and to 31% for liver metastases.

Colonic Neoplasms↗
PubMed1985

[Tumors of the small intestine--diagnosis, therapy and prognosis].

Between 1965 and 1983 91 patients suffering from primary tumors of the small intestine underwent surgical treatment. These patients comprise 1.24% of the total number having gastrointestinal tumors in that period. In 33% exact preoperative diagnosis was set. The delay in establishing diagnosis (6.3 months) was due to nonspecific symptoms. The majority of patients underwent operation because of vital indication without former specific investigation. Benign tumors could be resected radically without lethality. Curative resection could be performed in 62.5% and palliative resection in 37.5% of malignant lesions. Surgical lethality was 17.8%. The most common histologic type were the adenocarcinoma at one side and the adenoma at the other. The 5-year-survival-rate for curatively resected patients ranged from 60% for carcinoids, 25% for carcinomas up to 20% for lymphomas. The mean survival rate for patients who underwent curative resection was 44.12 months, for those with palliative treatment 13.37 months. 18 patients, 51.4% of the curatively treated group, are still alive, mean follow-up time being 5 years. Rareness, challenge in diagnosis, surgical procedures, postoperative complications, reoperation frequency and long-term prognosis seen from various points of view are discussed. Our study emphasizes the importance of thorough gastroenterologic investigation of patients with tumor-suspective abdominal symptoms and the eminence of explorative laparotomy as final diagnostic and therapeutic step as well as the postulation for ultimate surgical radicality.

Age Factors↗
PubMed1983

[Late results after conservative treatment of juvenile leg fractures].

In 50 patients, who had had tibiofibular or isolated tibial fractures in childhood, we have done a clinical and radiological assessment after completion of growth. The length of both calves was compared exactly with orthoradiographic measurements. The length of the lower limbs was identical in 20 subjects and it differed by maximally two centimeters in 30 subjects, in twelve of which there was a residual deviation of the axis of five to nine degrees. From the comparison of the radiographs at the end of treatment and during the control examination it became clear that due to the continuing growth the axial deviations would decrease by maximally seven degrees in children under twelve whereas they would remain virtually constant after the age of twelve. Therefore axial deviations up to five degrees are acceptable in children under twelve years but they must be avoided after the age of twelve. Torsional dislocations must be corrected anyway. In children under twelve years lengthening occurs due to hyperemia of the epiphyseal junction. However, beyond twelve shortening of the fractured calf occurs. Therefore an initial shortening of maximally one centimeter is acceptable in children under twelve. But in older children the initial consolidation with an equal length of legs must be attempted in order to prevent a permanent difference in length after the completion of growth.

Adolescent↗
PubMed1980

Symptomatology and psychological aspects of male sexual inadequacy: results of an experimental study.

Forty-two male patients and their sexual partners were studied. Sixteen of the patients had psychogenic erectile failure (eight each with the primary and secondary forms), 16 were premature ejaculators, and 10 had diabetes-related impotence. Because of the higher mean age of the diabetics, two control groups were used, an age-matched older group (eight healthy males and their partners) and an age-matched younger group (16 healthy males and their partners). The results for the various groups on a semi-standardized interview about sexual behavior and on five psychological assessment scales were compared. Of the 88 questions on the semi-standardized interview, 11 permitted assignment of the patients to the correct group. The diabetics suffered from "prevailing erectile impotence." They viewed themselves as being less disturbed sexually than the other patients did, although on the basis of their symptoms their impotence was actually more severe. The patients with psychogenic erectile impotence had a "situational" sexual disorder in which sexual anxiety played an important role. They viewed themselves as more insecure than the diabetics and the controls and they overidealized their partners and mothers. There appear to be two subgroups of premature ejaculators: The E1 group of patients seemed to be less "neurotic" than the E2 group. On the psychological measures the latter was quite similar to the group of patients with psychogenic erectile impotence. All patient groups except E1 were significantly more depressed than the control groups.

Adult↗
PubMed1980

Psychophysiological aspects of male sexual inadequacy: results of an experimental study.

Forty-two male patients and their sexual partners were studied: 16 patients with "psychogenic" erectile failure (eight each with the primary and secondary forms), 16 premature ejaculators, and 10 patients with diabetes-related impotence. Due to the higher mean age of the diabetics, an age-matched older control group (eight healthy males and their sexual partners) and an age-matched younger control group (16 healthy males and their sexual partners) were also studied. In an experimental situation various psychophysiological parameters were evaluated. The viewing of films depicting sexual behavior produced psychophysiological reactions in all subjects. The patient groups and the controls differed on the following five parameters: amount of increase in systolic blood pressure, amount of increase in number of spontaneous fluctuations in skin resistance, erection amplitude, latency of erection, and duration of erection. In the diabetic group the three erection parameters were very depressed. In the group with primary psychogenic erectile impotence all five parameters were lower than in the controls, with the greatest difference in spontaneous fluctuations in skin resistance. The psychophysiological profile of the group of patients with secondary psychogenic erectile impotence was surprisingly similar to the profile of the diabetics, with a sharp increase in systolic blood pressure and in spontaneous fluctuations in skin resistance, but very depressed erection parameters. There were no marked differences between the controls and the premature ejaculators. There were only a few correlations between self-rated sexual arousal and psychophysiological measures of sexual stimulation and these were not very high. They were found mainly in the patient groups.

Adult↗
PubMed1979

Pituitary gonadal system function in patients with erectile impotence and premature ejaculation.

The pituitary testicular system was studied in men with psychogenic impotence. Eight patients with primary erectile impotence age 22--36 years, eight men with secondary erectile impotence age 29--55 years, and 16 men with premature ejaculation age 23--43 years were studied. The last group was further divided into two subgroups: E1 (n = 7) patients without and E2 (n = 9) patients with anxiety and avoidance behavior toward coital activity. Sixteen normal adult men age 21--44 served as a control group. Diagnosis was made after psychiatric and physical examinations. Patients complaining primarily of loss of libido were not considered in the study. Ten consecutive blood samples were obtained over a period of 3 hr from each patient. Luteinizing hormone (LH), total testosterone, and free (not protein-bound) testosterone were measured. Statistical analysis revealed no significant differences between patients and normal controls.

Adult↗
PubMedDate not supplied

The multidrug-resistance modifiers verapamil, cyclosporine A and tamoxifen induce an intracellular acidification in colon carcinoma cell lines in vitro.

In this study we have investigated the effects of the multidrug-resistance (MDR) modifiers verapamil (VPM), cyclosporin A (CsA) and tamoxifen (TMX) on the intracellular pH(pHi) of four colon carcinoma-derived cell lines with low P-glycoprotein expression (CaCo-2, HT-29, SW 620 and SW 480). Addition of VPM (1 mu M), CsA (1 microgram/ml) or TMX (2 microM) in HEPES- or bicarbonate/CO2-buffered Ringer's solution was followed by dose-dependent and reversible decreases of the pHi (0.1-0.3 units) of all cell lines, as measured ratiometrically by the changes in the pH-dependent fluorescence of bis(carboxyethyl)carboxyfluorescein (BCECF). Testing the effects of the resistance modifiers on the Na+/H+ antiporter and bicarbonate trans-porters under appropriate buffer conditions and addition of inhibitors (amiloride, DIDS) revealed that the chemomodulator-induced acidification does not interfere with the function of these major pHi-regulating acid-base transporters. The induction of changes in pHi shows no correlation with MDR-reversing activity of the drugs and our data do not support the P-gp-inhibition-mediated accumulation of acidic substrates as underlying mechanism. In addition to the P-gp-directed MDR-reversal, chemomodulator-induced intracellular acidification may enhance the chemosensitivity of the cells especially under alkaline extracellular conditions, and contribute to the decreased efficacy of MDR-modifiers in acidic extracellular environments and to the chemosensitising effect of VPM in P-gp-negative cell lines.

ATP Binding Cassette Transporter, Subfamily B, Mem↗