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Biomedical subjects

B Dreuw

Publications and source records attributed to B Dreuw.

At least 19 recordsLinked to original sources
PubMed2002

[Colonic J-pouch reconstruction in cases of insufficiency and severe complications after ileocecal pouch in rectal cancer].

In order to reduce the high frequency of bowel movement after resection of the rectum in cases of rectal cancer, the creation of a colonic J-pouch was developed. Meanwhile this operation is well established. As a variation to the standard technique, von Flüe introduced in 1994 the interposition of an ileocecal segment, intended to improve the reservoir function via its own distensibility. Despite the conserved neural and vascular integrity of the ileocecal segment, major complications arise such as pouchitis with necrosis. In these cases, resection of the pouch and permanent discontinuity of stool passage is routine therapy. Patients with permanent stoma face many difficulties both physical and psychological, and often the quality of life diminishes. In the literature there is no detailed case of colonic J-pouch reconstruction following resection of an insufficient ileocecal pouch. This operation is technically highly demanding but feasible.

Anal Canal↗
PubMed2001

[Prognostic factors for development of peritoneal carcinosis in stomach carcinoma].

OBJECTIVE: Several adjuvant therapy concepts have been developed to improve the treatment of gastric cancer patients. Dealing with intraperitoneal chemotherapy, it seems to be useful to determine suitable prognostic factors for the occurrence of peritoneal carcinosis, as it is possible to select patients who may profit from this therapy. METHODS: Between June 1975 and December 1999 resection of gastric cancer was performed in 575 patients. From 1 January 1986 clinical data were recorded prospectively, before that time, retrospectively. The complete data concerning preoperative diagnosis, operation, histology, postoperative course and survival time were documented in an Excel file for statistical analysis. Multivariate analysis was performed using the chi-squared logistic regression test. RESULTS: Significant correlation was found between the occurrence of peritoneal dissemination and tumour stage pT3, pN2, G3, cancer of the whole stomach and cancer at the anastomotic site after partial gastric resection. Lauren classification, signet-ring cell cancer, liver metastasis and tumour localisation in the distal or proximal stomach showed no significant correlation to peritoneal carcinosis in the multivariate analysis. However, only one-third of patients with liver metastasis had simultaneous peritoneal dissemination. CONCLUSION: The results show a clinical correlation of tumour localisation, infiltration of the serosa, lymph node metastasis and grading with peritoneal dissemination. The present data serve as a basis for further histochemical and molecular biological investigations e.g. of the expression of adhesion molecules to determine the risk of peritoneal tumour dissemination after gastric cancer.

Adult↗
PubMed2001

Colon interposition for esophageal replacement: isoperistaltic or antiperistaltic? Experimental results.

BACKGROUND: Isoperistaltic colon is preferred to antiperistaltic colon for esophageal replacement, but experimental data do not exist to support this practice. METHODS: In 7 dogs a 20 cm long colon loop was interposed between the skin and the small bowel, isoperistaltically in 3 dogs and antiperistaltically in 4 dogs. Three months later five strain-gauges were implanted and evacuation was investigated by motility testing, barium studies, and scintigraphy. RESULTS: Motility recording showed normal colon motility in the excluded loops. Quiescent states (duration 40.2 +/- 13.6 minutes) were followed by contractile states (duration 7.5 +/- 2.4 minutes, frequency 3.3 +/- 0.6 per minute). The main peristaltic direction of isoperistaltic loops was isoperistaltic, and the main peristaltic direction of antiperistaltic loops was antiperistaltic. Evacuation took place exclusively during the contractile status. Half time emptying was more rapid in isoperistaltic loops (35 +/- 11 vs 69 +/- 16 minutes). The content of antiperistaltic loops was held back by antiperistaltic activity. Application of oatmeal porridge into the loops shortened the quiescent status from 40.2 to 13.2 +/- 4.8 minutes. CONCLUSIONS: The colon graft for esophageal replacement is an active system. Food is stored during the quiescent states and evacuated during the contractile states. The original peristaltic direction is preserved so that retroperistalsis in antiperistaltic loops may lead to patient discomfort and pulmonary complications.

Animals↗
PubMed2000

Short-term absorbable material for diaphragmatic replacement.

To evaluate absorbable materials for use for replacement of the diaphragm, we implanted materials in experimentally-created diaphragmatic defects in pigs. As a short-term absorbable material, bovine serosa (BS) was used. Its absorption was complete after 4-6 weeks. In a control group, the defect was repaired with a continuous running polypropylene suture. In two other groups the defect was closed with lyophilized dura (LD) and a modified transverse abdominal muscle flap according to Hecker, respectively. Physical studies (load capacity and elasticity) and histologic investigations were performed in one-half of the animals of each group after 3 and 6 months, respectively. Considering their physical properties, it could be shown that all materials tested are suitable for replacement of the diaphragm, but that BS best resembled native diaphragm. We conclude that short-term absorbable BS is suitable for replacement of the diaphragm in pigs.

Animals↗
PubMed2000

Appendix and cecum. Embryology, anatomy, and surgical applications.

Surgeons should be familiar with surgery of the cecum and appendix because the diseases of this region, especially appendicitis, are the most common indications for surgical exploration. Usually, diagnosis of appendicitis and appendectomy are not difficult, but atypical location of the appendix or other anatomic anomalies can make the diagnosis of appendicitis and appendectomy difficult. In cases of atypical anatomy or diffuse clinical picture, especially in young adults or elderly patients, the spectrum of embryologic and anatomic anomalies must be kept in mind to make the correct treatment decision for individual patients. If doubt persists, explorative laparotomy must be performed to avoid overlooking rare, acute, intra-abdominal abnormalities.

Adult↗
PubMed1998

[Combined pH measurement and multiple impedance variation assessments--validation of a new technique for detection of non-acid reflux in the esophagus].

In 10 patients with gastroesophageal reflux disease, defective lower esophageal sphincter and normal motility pH and impedance were measured parallel over 24 hours. All patients had a reflux score > 40 with a total of 736 reflux episodes registered by the pH metry of which 724 (sensitivity: 98.9%) were recognized by impedancemetry and with additional 292 reflux phases registered at a stomach pH > 4 by the impedancemetry of which none was recognized by the pH metry as a reflux of pH > 7. With the multiple impedancemetry a reliable recognition of gastroesophageal reflux is possible, independently of the pH and this makes it possible to recognize gastroesophageal reflux also at a non acid milieu of the stomach, e.g. under acid suppression medication or after stomach resection.

Electric Impedance↗
PubMed1998

[Interdisciplinary multi-modality therapy of advanced hypopharyngeal and proximal esophageal carcinomas].

A multimodal interdisciplinary concept including an aggressive neoadjuvant radiochemotherapy and a multivisceral resection with esophagolaryngectomy and bilateral modified neck dissection was introduced for the treatment of tumors of the cervical esophagus and hypopharynx. In 75% of the patients a R0-resection was achieved resulting in a 5-year survival rate of 38.5% and good functional results. Free jejunal interposition was the most favorable reconstruction because gastric transposition was followed by an increased rate of anastomotic insufficiencies and stenoses requiring bouginage.

Carcinoma, Squamous Cell↗
PubMed1997

[Diaphragmatic injuries--classification, diagnosis and therapy].

Diagnosis of diaphragmatic rupture is often missed after blunt thoracic and abdominal injuries. Rupture of the diaphragm is caused either by direct or indirect violence. The clinical manifestations are unpredictable and of infinite variety, and, especially in massively traumatized patients, masked by other injuries. Between 1987 and 1995, 17 patients were treated for traumatic injury of the diaphragm. Four of 17 patients sustained isolated diaphragmatic rupture; in 13 the rupture was combined with other injuries. Preoperatively the following diagnostic procedures were performed: ultrasonography in 12 patients, chest X-ray in 6, computed tomography of the abdomen in 2, water soluble enema into the stomach in 1, and computed tomography of the thorax in 1 patient. Therapy of diaphragmatic injury was performed in 15 patients within 2 days, in one within 1 year and in one 23 years after the accident. Two patients died due to accompanying injuries.

Abdominal Injuries↗
PubMed1997

[Diaphragm replacement. An animal experiment study].

BACKGROUND: Only a few indications exist for diaphragm replacement: aplasias, tumours and accidents. The defect may be so extensive that it is impossible to close the gap. Allogenic and autologous materials are proposed for replacement of the diaphragm. The disadvantages of allogenic materials are recurrence rates of up to 20% and a high rate of malalignment of thoracic muscles and bones; the implication of autologous materials requires a longer operation time and no long-term results exist. To avoid these disadvantages, we have tested a material from bovine serosa, which is absorbable for a short time, for diaphragm replacement. METHODS: The merits of four methods of diaphragmatic hernia repair were evaluated in animals. One hundred Sprague-Dawley rats underwent laparotomy. The control group had an incision in the diaphragm with primary repair. The other four groups underwent partial resection of the left hemidiaphragm. The defects were repaired in 20 rats with lyophilized dura, in 20 with polytetrafluoroethylene (PTFE), in 20 with autologous transversus muscle and in another 20 with absorbable serosa from a cow. The animals were followed up by electromyography (EMG) and post-mortem physical and histological examinations after 3 and 6 months. RESULTS: Eighty-nine animals survived the operations. The EMG showed normal function for the absorbable material and the transversus muscle. Only scanty physiological waves were recorded in the PTFE group. The examination for stretching and stress showed good results for all materials tested. The histological examinations showed strong foreign body reactions in the dura and PTFE groups. The absorbable bovine serosa had vanished after 3 months postoperatively. CONCLUSION: We conclude that bovine serosa can be recommended for the treatment of diaphragmatic defects.

Absorption↗
PubMed1997

[Laparoscopic fundoplication--prevention of complications].

False indications, inadequate procedures and incorrect technique cause complications after laparoscopic antireflux procedures. Indication for operative treatment are esophagitis grade III and IV. Requirement of life-long treatment as well as persisting esophagitis after conservative treatment are indications in patients with esophagitis grade I and II. Preoperative evaluation includes endoscopy with biopsy, 24-h pH measurement and manometry. Therapy of choice is 360 degrees Nissen fundoplication analogue to the open procedure. In case of impaired esophageal contractility, a Toupet fundoplication is performed. Essential steps of the operative technique are prescribed with respect to potential peri- and postoperative complications. With crucial indication, careful preoperative evaluation and subtle technique, a fundoplication performed by an laparoscopic experienced surgeon is safe and efficient.

Follow-Up Studies↗
PubMed1996

[Adenocarcinoma of the esophagogastric junction: association with Barrett esophagus and gastroesophageal reflux--surgical results in 122 patients].

OBJECTIVE: To investigate the surgical results of adenocarcinoma of the esophagus and esophagogastric junction and its relationship with gastroesophageal reflux disease (GERD) and Barrett's esophagus. BACKGROUND: The incidence of adenocarcinoma of the cardia is continuously rising. Specialized intestinal metaplasia in Barrett's esophagus seems to be the source of these tumors. Barrett's esophagus is end stage GERD. In experimental studies alkaline reflux give rise of Barrett's esophagus and adenocarcinoma. PATIENTS: 122 patients with adenocarcinoma of the cardia and 121 patients with squamous cell tumor of the esophagus. METHODS: All esophageal resections between 11/85 and 2/95 were retrospectively analyzed. The relationship of gastroesophageal reflux disease, Barrett's esophagus and malignancy was compared between both groups using parameters of case history and histological sections. Survival was analyzed for tumorstage, T-and N-stage and R-classification. RESULTS: 5.9% of the adenocarcinomas were stage I, 44.1% stage II, 41. 5% stage III and 8.5% stage IV. Heartburn, regurgitation, consumption of H2 blockers or Barrett's mucosa were significantly more frequent for adenocarcinomas. A 5 year survival of 100% was seen for stage I tumors. Invasion of t he muscular layer reduced survival to 50%, lymph node invasion to 20%. R0-resection had a survival of 40%. CONCLUSIONS: A relationship of GERD and adenocarcinoma of the cardia seems to be likely in our cases. Most patients had advanced malignancy. Survival is good only for early cases. Prevention of tumor genesis with effective antireflux surgery in case of alkaline reflux seem to be the best therapeutic decision.

Adenocarcinoma↗
PubMed1996

[Gastroesophageal reflux--surgical indications, laparoscopic surgical technique, results].

OBJECTIVE: To investigate criteria for indication to surgery and results of laparoscopic fundoplication. BACKGROUND: Gastroesophageal reflux is a common problem in well developed countries. Beside clinical symptoms of heartburn and regurgitation complications may occur like esophagitis, bleeding, ulceration, mucosal metaplasia and loss of motility. A connection of reflux disease, Barrett's esophagus and adenocarcinoma of motility. A connection of reflux disease, Barrett's esophagus and adenocarcinoma of the esophagogastric junction is discussed. In some patients medical treatment is complicated by relapse, persistent or progressive disease. For these patients laparoscopic antireflux surgery may be an effective alternative. PATIENTS: 22 patients with chronic gastroesophageal reflux disease. METHODS: Since 9-2-1922 patients with gastroesophageal reflux disease were prospectively evaluated and treated by laparoscopic Nissen fundoplication. RESULTS: 11 patients had frequent recurrent disease, 9 persistent reflux and 2 a stricture while on medical treatment. All had pathologic reflux on 24 hour pH monitoring and defective sphincter on standard manometry. Beside an intraoperative pneumothorax there was no intraoperative complication. Postoperative 2 patients had a temporary and 1 mild persisted dysphagia. None had recurrent reflux. 10 patients were reevaluated one year after surgery. None had an esophagitis, abnormal reflux or an insufficient or hypercontinent sphincter. CONCLUSIONS: Patients with recurrent or persistent reflux while on medical treatment with abnormal reflux on pH monitoring and defective sphincter on manometry can be treated by laparoscopic Nissen fundoplication with good results.

Adult↗
PubMed1996

[Subtotal esophagectomy with stomach transposition as standard operation for adenocarcinoma of the esophagogastric junction].

A modified Ivor Lewis operation was introduced to the surgical treatment of adenocarcinoma of the oesophagogastric junction in an investigative study of 122 consecutive patients. The procedure consisted of a transmediastinal subtotal oesophagectomy with mediastinal lymphadenectomy to the level of the tracheal bifurcation, a proximal 4/5th-gastrectomy with D2-lymphadenectomy and splenic hilar dissection and was completed by a collar oesophagogastrostomy using a gastric tube from the greater curvature. The new concept was followed by good oncologic results without anastomotic recurrencies and a reduction in potential lethal complications like mediastinal anastomotic leakage.

Adenocarcinoma↗
PubMed1995

[Esophageal replacement--indications, technique, results].

Between November 1985 and January 1994 a total of 239 patients were operated for replacement of the esophagus and primary reconstruction. Of these 3 had benign disease and 236 had malignancy. Continuity of the alimentary tract was restored in 202 cases by stomach transposition, in 16 cases by colon interposition and in 21 cases by free jejunal autograft. Complication rate of surgical resection was 36.8%, lethality 5.1%. Lethality of coloninterposition was as low as for gastric transposition (6.3 vs 5.5%). None of the patients with free jejunal autograft died during hospital course (p < 0.001). Survival rates by life-table analysis for the whole group were 65%, 42%, 36%, 32%, and 22% after 1, 2, 3, 4 and 5 years, respectively. The malignant tumors consists of 111 esophageal carcinomas, 104 carcinomas of the esophagogastric junction and 21 carcinomas of the hypopharynx. 15.1% of the tumors were staged I, 42.7% II, 35.7% III and 6.5% IV. The collectives for esophageal carcinoma and cardia carcinoma were equal for age, sex, and distribution of tumor stages. The survival rates for both groups were similar. Differences occurred in a three times higher rate for concomittant hiatal hernia and history of reflux esophagitis in the cardia carcinoma group.

Adult↗
PubMed1994

Vectormanometry for differential diagnosis of fecal incontinence.

PURPOSE: This study was designed to investigate the reliability of three-dimensional vectormanometry for differential diagnosis of fecal incontinence. METHODS: Eight-channel, continuous pull-out perfusion manometry was performed on 23 female patients with traumatic (n = 11) or idiopathic (n = 12) incontinence, respectively. RESULTS: At rest, the minimum sector pressure of patients with traumatic incontinence (32 +/- 14 mmHg) was significantly lower than it was in the controls (76 +/- 16 mmHg) and in those with idiopathic incontinence (64 +/- 28 mmHg) (P < 0.001). At maximum squeezing, the minimum sector pressure was 57 +/- 22 mmHg in patients with traumatic incontinence and 79 +/- 33 mmHg in those with idiopathic incontinence, both being significantly lower than in the control group with 152 +/- 27 mmHg (P < 0.001). The asymmetry index of the patients with a sphincter defect was significantly higher, both at rest (23 +/- 13 percent) and squeeze (26 +/- 12 percent), in comparison with the control group (7 +/- 2 percent at rest and 6.2 +/- 1.6 percent at squeeze) and the patients with idiopathic incontinence (10 +/- 5 percent at rest and 8.4 +/- 4 percent at squeeze). CONCLUSION: Three-dimensional vectormanometry identifies localized pressure deficits in the anal canal, thereby differentiating between sectorial and global sphincter insufficiency.

Adult↗
PubMed1994

Measuring esophageal motility with a new intraluminal impedance device. First clinical results in reflux patients.

BACKGROUND: The study was undertaken to determine the validity of intraluminal impedance measuring for the diagnosis of esophageal motility disorders in reflux patients. METHODS: A new impedance device was used for the detection of esophageal motility patterns in a prospective study with 10 volunteers and 10 patients with reflux esophagitis grade II-III. Perfused manometry was correlated with the impedance tracings. Test meals were saline and curd in three different preparations with liquid to semisolid viscosity. RESULTS: There was a marked delay in esophageal transport with increasing viscosity of the bolus (p < 0.01). A significant (p < 0.001) delay of the bolus transport in the inflamed esophageal areas was seen in reflux patients. A reduced contractility of the lower esophagus and the lower esophageal sphincter was detected by the impedance procedure in reflux patients, indicating that the pathologic motility patterns in reflux esophagitis are most likely secondary to the tissue inflammation. CONCLUSION: We conclude that impedance procedures may give additional significant information about bolus transport and esophageal wall movements.

Adult↗
PubMed1993

Pharmacokinetics and pharmacodynamics of famotidine in patients with reflux oesophagitis.

The pharmacokinetics, pharmacodynamic effect and clinical efficacy of famotidine were studied in 10 patients with reflux oesophagitis Grades I and II. For the pharmacokinetic studies the patients received 20 mg famotidine i.v. The half-life of famotidine was 3.8 h, the total plasma clearance was 297 ml.min-1, and a steady state volume of distribution of 1.2 l.kg-1 was found. For pharmacodynamic assessment, intraoesophageal pH-metry was performed without and after acute treatment with famotidine 20 mg i.v. and following 3 weeks of oral famotidine 80 mg b.d. The resultant percentage total acid exposure time (pH < 4 within 24 h) were 23.9%, 19.0% and 19.2% (median), respectively (NS). At the end of 6 weeks of oral therapy, symptomatic and endoscopic improvement had occurred in 9 and 5 patients, respectively. Our study shows that the pharmacokinetics of famotidine in patients with reflux oesophagitis is comparable to that in healthy volunteers and peptic ulcer patients. The clinical response to the treatment appeared comparable to that found after other H2-receptor antagonists.

Adult↗