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Biomedical subjects

A Müldner

Publications and source records attributed to A Müldner.

5 recordsLinked to original sources
PubMed2005

Depth of endoscopically placed sutures: an experimental study in a human cadaver model.

BACKGROUND: Endoscopic suturing devices offer interesting access for interventional procedures used on the gastrointestinal tract. For the time being, the main indication is endoluminal suturing at the gastroesophageal junction for the management of gastroesophageal reflux disease. There is some evidence that endoluminal endoscopic suturing offers an alternative to the closure of esophageal fistulas and to the fixation of feeding tubes and stents in the near future. A review of the literature found no anatomic data on wall layers stitched by sutures. The aim of this study was to determine the depth of sutures placed endoscopically in the esophagus of a human cadaver model. METHODS: Altogether, 62 sutures were placed in the esophagi of 10 cadavers (complete exenterative cadaver model) at three different suction levels (0.4, 0.6, and 0.8 bar) using the EndoCinch suturing machine. After preparation of the esophagus from its mediastinal bed, all sutures were fixed in formalin and stained with hematoxylin and eosin for histologic examination. RESULTS: No sutures were placed in the mucosa alone. As observed, 1.6% were placed in the submucosa, 4.8% in the circular muscularis propria, and 56.5% in the longitudinal muscularis propria, with 37% placed transmurally. At a suction level of 0.4 bar (0.6, 0.8 bar), 0% (0%, 1.6%) were placed in the submucosa, 3.2% (0%, 1.6%) in the circular muscularis propria, and 11% (25.8%, 12.9%) in the longitudinal muscularis propria, with 12.9% (6.5%, 17.7%) placed transmurally. CONCLUSIONS: This study reports, for the first time, a systematic examination of the depth of sutures placed endoscopically in the esophagus. Most of the sutures were found in the muscular wall of the esophagus at a suction level of 0.6 bar. Also, transmural placements were seen. Reduction of suction pressure may lead to a decrease in transmural sutures.

Aged↗
PubMed2005

Endoscopically controlled strictureplasty for stenotic colorectal anastomosis.

Various different techniques have been described for the treatment of benign colorectal anastomotic strictures. Some strictures are resistant to standard dilation therapy. A quick and effective technique is described here for the treatment of colorectal strictures. It consists of cutting the stricture using a flexible stapler system. This is performed under endoscopic guidance and control using a colonoscope inserted alongside the stapler. The patient treated as described here experienced good functional and anatomical results.

Anastomosis, Surgical↗
PubMedDate not supplied

Delayed decrease of excitatory amino acid neurotransmitters in parietotemporal cortex and hippocampus after complete cerebral ischemia in aged rats.

A 15-min period of complete cerebral ischemia (CCI) was used in aged rats to investigate changes in tissue contents of the amino acid neurotransmitters (AANT) glutamate (glu), aspartate (asp), gamma aminobutyric acid (gaba) and glycine (gly) in parietotemporal cortex and hippocampus during ischemia and up to 96 h of postischemic recirculation. The AANT were determined by HPLC. The excitatory AANT glu and asp showed a first decrease at the end of CCI in hippocampus and after 1 h of postischemic recirculation in parietotemporal cortex, reflecting a release of these AANT into the extracellular space with a further loss into the blood. A second decrease in glu and asp was seen after 24 h of postischemic recirculation in hippocampus and after 48 h in parietotemporal cortex. This coincides with previously described disturbances in energy metabolism from 24 h to 96 h in hippocampus and from 48 h to 72 h in parietotemporal cortex in the same experimental model in aged rats. This might be a causal factor in delayed postischemic neuronal damage. A comparison with investigations in young animals reveals an enhanced decrease of glutamate and aspartate tissue contents during the postischemic recirculation period in old rats indicating an enhanced release of these amino acid neurotransmitters. A significant decrease of gaba tissue content seen in hippocampus at 48 h and 72 h of postischemic recirculation with subsequent disproportion of inhibitory AANT (lower) to excitatory AANT (higher) might reflect a greater vulnerability of hippocampus than of parietotemporal cortex to ischemia. A significant decrease in the NMDA-receptor coactivator gly in parietotemporal cortex at the end of CCI and at 48 h, 72 h, and 96 h of postischemic recirculation, which was not seen in hippocampus, might be another reason for higher vulnerability of hippocampus to ischemia.

Journal Article↗