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B Bittorf

Publications and source records attributed to B Bittorf.

6 recordsLinked to original sources
PubMed2003

[Sacral nerve stimulation in the treatment of faecal incontinence].

BACKGROUND: Sacral nerve stimulation is a recent development in the treatment of faecal incontinence. This paper reports the experiences of a single center on the use of this technique since its first application. PATIENTS AND METHOD: Based on the functional results of a temporary test stimulation phase, 16 patients underwent operative implantation of a permanent neurostimulation device. Due to a functional deficit of the morphologically intact anal sphincter, all patients suffered from incontinence for liquid and solid stool. The aetiology varied among the patients. The median duration of symptoms was 8.5 years (2-30). Clinical function was evaluated by standardized questionnaires, the Cleveland Clinic incontinence score and the disease specific quality of life instrument (FIQL-ASCRS) before and during stimulation. Anorectal physiology was tested by anorectal manometry. RESULTS: Functional improvement was achieved in 94% of the patients. At a median follow-up of 32.5 months (3-99) treatment was successful in 81%. The percentage of incontinent bowel movements decreased from a median of 40% (5-100) before stimulation to 0% (0-20) with stimulation ( P=0.001). The Cleveland Clinic incontinence score improved from a median of 17 (11-20) to 5 (0-15) ( P=0.003). The quality of life index was improved in all categories.Mean squeeze pressure was increased form a median of 44 to 75 mmHg with stimulation ( P=0.003) and maximal squeeze pressure from a median of 69 to 97 mmHg (P=0.009). Resting pressure, perception, urge threshold and maximum tolerable volume were not significantly changed. CONCLUSION: Sacral nerve stimulation is an effective treatment for faecal incontinence. Morbidity is low. Sacral nerve stimulation is indicated, if conservative treatment fails and more conventional surgical approaches are of limited success.

Adult↗
PubMed2003

Rectal resection with low anastomosis: functional outcome.

OBJECTIVE: Function after anterior, low anterior and intersphincteric resection for rectal cancer was studied. METHOD: Of 139 patients 122 responded to a standardized questionnaire (Cleveland Clinic Continence Score) 108 +/- 46 weeks postoperatively and 70 underwent anorectal manometry at 26 +/- 15 weeks. RESULTS: The postoperative continence score was dependent on the procedure (anterior resection 4.1 +/- 4.6, low anterior resection 6.9 +/- 5.6, intersphincteric resection 11.5 +/- 5.2; P < 0.0001). It was poorer after radiochemotherapy (9.0 vs. 5.7; P = 0.030), but after colonic pouch reconstruction there was no significant difference between low anterior resection (5.6 vs. 7.3) and intersphincteric resection (10.0 vs. 12.5). Mean and maximal resting pressures were significantly reduced after intersphincteric resection (24 +/- 9 and 40 +/- 13 mmHg, respectively, P < 0.001) and further reduced by radiochemotherapy. Squeeze pressure was unaffected by the operative procedures and radiochemotherapy. Maximum tolerable volume and rectal compliance were reduced, after both low anterior and intersphincteric resection. Statistical correlation between continence score and maximal resting pressure (P = 0.014), mean resting pressure (P = 0.002), urge volume (P = 0.037), and neorectal compliance (P = 0.0018) reached significance. Satisfaction with the functional outcome was expressed by 71% of patients. CONCLUSION: After rectal resection the degree of impaired continence depended on the operative procedure and the form of reestablishment of intestinal continuity. Radiochemotherapy affected the outcome adversely. Despite reduced function, overall patient satisfaction was high.

Adenocarcinoma↗
PubMed2001

Multiple primary malignancies: An epidemiological and pedigree analysis of 57 patients with at least three tumours.

AIM AND METHODS: Data of our patients with at least three primary malignancies were retrospectively analysed to detect any remarkable patterns which might be of interest for follow-up or early tumour detection and to identify a possible hereditary cancer predisposition. From 1.1.1954 to 1.8.1995 57 patients (0.1%) among a grand total of 52 398 cancer patients had a minimum of three malignancies. RESULTS: The 5-year survival rates after colorectal, bladder, prostate, uterine corpus and gastric cancer were higher than those seen in patients with the corresponding solitary tumours. In both sexes, the mean interval between the individual tumours was greater (4.0 years) between the first and second tumours than between the second and third (2.5 years). In women, the intervals were roughly twice as long (6.8 and 3.7 years) as in men (3.7 and 2.0 years). 40.4% (n=23/57) had a colorectal, 28.1% (n=16) a bladder, and 41.7% (n=15/36 men) had a prostate carcinoma. 66.7% (n=14/21 women) contracted at least one gynaecological tumour. In 24 families HNPCC, in one a Li-Fraumeni Syndrome, and in another Hereditary Diffuse Gastric Cancer was suspected.

Adult↗
PubMed2000

[Can continence function after rectal resection be prognostically estimated?].

AIM: To determine clinical and physiologic parameters enabling the prognosis of continence after protective ileostomy closure secondary to rectal resection for rectal cancer. METHODS: Patients who had undergone rectal resection (n = 65, of whom 24 had had radiochemotherapy) were evaluated by clinical examination, anorectal manometry and orthograde contrast enema before ileostomy closure. Continence was evaluated by clinical findings 91 +/- 52 weeks after stoma closure with the help of standardized questionnaires and classified according to the Wexner continence score. The relationship between findings before stoma closure and continence score was calculated with Pearson's correlation coefficient. RESULTS: Correlations were found to be significant between the continence score and the level of anastomosis (r = -0.58, p < 0.001), median resting pressure (r = -0.52, p < 0.001), rectal compliance (r = -0.43, p < 0.001). Additionally, radiochemotherapy impairs continence (p = 0.0001). Correlations were not significant between continence and functional sphincter length, squeeze pressure, threshold for perception, urge and maximal tolerable volume, and continence for semiliquid contrast medium. CONCLUSION: Incontinence after rectum resection is multifactorial: the level of anastomosis, resting pressure, rectal compliance and radiochemotherapy all play a dominant role. Based on these findings, the continence score can be calculated before closure of a diverting ileostomy by applying multivariate analysis with the help of the following formula: Continence score = 18.23 - 0.94 x level of anastomosis - 0.18 x resting pressure + 3.72 x radiochemotherapy.

Adult↗
PubMedDate not supplied

[Rare case of chronic mesenteric ischemia after occlusion of the celiac trunk in a 15-year old boy].

BACKGROUND: Chronic mesenteric ischemia is extremely uncommon in childhood. Occlusion of the celiac axis by the median arcuate ligament (celiac axis compression syndrome) has been only described as a disorder of younger adults yet. CASE REPORT: We present a 15-year-old boy with a 18-month history of chronic intermittent upper abdominal pain. A chronic mesenteric ischemia due to compression of the celiac axis by the median arcuate ligament was recognized as cause of the complaints. Revascularisation by an autologous vein bypass from the abdominal aorta to the common hepatic artery led to restitution. CONCLUSIONS: Even in childhood intermittent abdominal pain may be generated by chronic mesenteric ischemia.

Abdominal Pain↗