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Christoph A Maurer

Publications and source records attributed to Christoph A Maurer.

12 recordsLinked to original sources
PubMed2007

Colonic lymphoid aggregates in slow transit constipation.

Information available on colonic lymphoid aggregates, apart from data of patients with inflammatory conditions, is scarce in other pathologic conditions. We investigated colonic lymphoid aggregates in patients with severe slow transit constipation, unresponsive to conventional therapeutic measures, and undergoing surgery for relief of their symptoms. Tissues from 27 patients with intractable slow transit constipation were obtained and compared with 10 controls. The number, diameter, lymphocyte distribution, and proliferative index were calculated and compared in both groups. Constipated patients displayed a significantly increased number of colonic lymphoid aggregates compared with controls. No differences were found concerning the other variables. The increase of colonic lymphoid aggregates found in severely constipated patients may represent a protective mucosal mechanism toward the chronic fecal stasis.

Adult↗
PubMed2006

Enteric neuropathology of the terminal ileum in patients with intractable slow-transit constipation.

Slow-transit constipation is usually considered a colonic motor disorder. However, there is some evidence that abnormalities may be present in locations other than the colon. In particular, several studies have reported abnormal motor activity of the small bowel in these patients. We evaluated the neuropathological aspects of the terminal ileum in patients with slow-transit constipation to see whether abnormalities are present that may explain an abnormal motility of the small intestine. Specimens of the terminal ileum were obtained from 16 female patients (age range, 42-76 years) with slow-transit constipation undergoing surgery for intractable symptoms. Fifteen age- and sex-matched controls were used for comparison. Histologic and immunohistochemical evaluation of the myenteric plexus and the smooth muscle of the proximal ileal resection margin was carried out by means of hematoxylin and eosin, trichrome and periodic acid-Schiff stain, neuron-specific enolase, S-100, CD117, CD34, anti-alpha-actin, desmin, and vimentin antibodies. The patient group displayed a significantly reduced number of glial cells, compared with controls, in both the submucosal and the myenteric plexus. Only 1 of the 3 populations of interstitial cells of Cajal (that associated with the deep muscular plexus) was decreased in patients. No differences were found between patients and controls concerning ganglia neurons, fibroblast-like cells, enteric neurons, apoptotic phenomena, and smooth muscle. Patients with slow-transit constipation display neuropathological abnormalities of the terminal ileum to a lesser extent than those we previously found in the colon, which might explain the abnormal motor aspects sometimes found in these patients.

Adult↗
PubMed2006

One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV).

INTRODUCTION: Guidelines for the treatment of complicated sigmoid diverticulitis recommend Hartmann's procedure or anastomosis with protective colostomy for Hinchey stage III diverticulitis and Hartmann's procedure only for Hinchey stage IV diverticulitis. We evaluated the outcome of patients with perforated sigmoid diverticulitis Hinchey III/IV undergoing one-stage colon resection and primary anastomosis without protective colostomy. METHODS: After implementation of a protocol to treat Hinchey III/IV diverticulitis with primary anastomosis without protective ileocolostomy, the patients' data were recorded prospectively between August 2001 and August 2003 and analyzed retrospectively from a computer-related database. RESULTS: Of 41 patients, 34 (81%) underwent one-stage sigmoid resection and primary anastomosis, 3 of 41 patients (7%) underwent primary anatomosis with protective ileostomy, and 5 of 41 patients (12%) had a Hartmann's procedure. The mortality was 11% in patients undergoing primary anastomosis and 60% in patients with Hartmann's procedure. The relative risk of co-morbidity factors for lethal outcome after sigmoid resection was 6.94 for preceding operations, 3.75 for renal failure or renal transplantation, and 3.25 for immunosuppression. CONCLUSIONS: One-stage sigmoid resection and primary anastomosis can be performed safely in nearly 90% of all patients with perforated sigmoid diverticulitis (Hinchey III/IV) by surgeons of different training levels. Patients with immunosuppression, chronic renal failure, liver cirrhosis, or previous organ transplantation or complex cardiovascular reconstructive procedures have a significantly increased risk of dying after sigmoid resection for perforated diverticulitis.

Anastomosis, Surgical↗
PubMed2005

Urinary and sexual function after total mesorectal excision.

The autonomous pelvic nerves are in close contact to the visceral pelvic fascia that surrounds the mesorectum. The concept of total mesorectal excsion (TME) in rectal cancer treatment has led to a substantial improvement of autonomous pelvic nerve preservation. Consecutively, this highly precise and sharp dissection technique under direct vision reduces the problem of accidental bladder denervation from 50-60% with conventional rectal cancer surgery to less than 20% with TME and the problem of postoperative impotence from 70-100% to less than 30%. The learning curve in this technically demanding procedure plays a major role with regard to a satisfying nerve preservation. The laparoscopic approach for TME allows to obtain similarly favorable results with regard to postoperative urogenital function, at least for tumors situated in the middle and upper third of the rectum, compared with open surgery. The present paper describes and depictures in detail the anatomy and the pathophysiology of autonomic pelvic nerves, the surgical technique for nerve preservation and gives a short overview of the results in the literature including own data.

Autonomic Nervous System↗
PubMed2004

Surgical management of large sessile villous and tubulovillous adenomas of the lower rectum.

BACKGROUND: Large sessile adenomas of the rectum are premalignant lesions necessitating complete removal. METHODS: We reviewed the data on 20 consecutive patients with large (>or=2 cm) sessile villous and tubulovillous adenomas of the lower two thirds of the rectum ( or=50% or an endosonographic staging of >or=uT2 underwent a low anterior resection of the rectum. The remaining 9 patients underwent a posterior full-thickness local bowel wall resection (modified Mason procedure). The median (range) follow-up period was 3.8 (0.7-8.2) years. RESULTS: Preoperative biopsy examination successfully excluded invasive carcinoma. Overstaging, however, occurred in 9 of 12 patients (75%) undergoing endosonography, resulting in surgical overtreatment of 4 patients. A curative resection (R0) was always achieved. Five patients had complications, but there was no in-hospital mortality and no cases of local recurrence. 4 out of 19 patients complained of minor stool incontinence, and 3 patients reported incomplete rectal emptying or constipation. Fourteen patients described the operative result as excellent (n = 7) or good (n = 7). CONCLUSIONS: Endosonography may lead to overstaging and overtreatment. An individualized approach based on the degree of adenomatous circumferential involvement and endosonographic staging showed no mortality, low morbidity, no local recurrence, and good functional medium-term results.

Adenoma, Villous↗
PubMed2004

Colon interposition for esophageal replacement: a single-center experience.

BACKGROUND: Gastric tube interposition has become the method of choice for esophageal replacement after esophagectomy. Colon interposition, on the other hand, is widely considered to be a method of last resort, associated with high morbidity and mortality. The present study reviews our experience with colon interposition for esophageal replacement. PATIENTS: Nineteen consecutive patients undergoing colon interposition for esophageal replacement between 1 January 1994 and 31 July 2001 were reviewed. Outcome was compared with international publications on colon interposition as well as with our results following gastric tube interposition (fundus rotation gastroplasty). RESULTS: Fourteen men and five women with a median age of 68 years (range 44-78) underwent colon interposition for benign ( n=9) and malignant ( n=10) lesions. Eighteen patients underwent trans-hiatal esophagectomy with cervical anastomosis, and one patient underwent thoraco-abdominal esophagectomy with intrathoracic anastomosis. Surgical morbidity was 36.8% (7/19). Anastomotic insufficiency and fatal mediastinal bleeding occurred in one patient each (5.3%). No cases of graft necrosis were observed, and no re-operations were necessary. In-hospital mortality was 15.8% (3/19), twice due to surgical complications (abdominal sepsis, mediastinal bleeding) and once due to pulmonary and cardiac failure. As a late complication, four patients (21.1%) developed anastomotic strictures that necessitated repeated endoscopic dilatation. CONCLUSIONS: Gastric tube interposition remains the method of choice for esophageal replacement. Colon interposition, however, is a valuable alternative with a good long-term function. Early mortality, however, remains a matter of serious concern.

Adult↗
PubMed2004

The bile acid nuclear receptor FXR and the bile acid binding protein IBABP are differently expressed in colon cancer.

Bile acids have been implicated in the development of colorectal cancers. We investigated the expression of the transcription factor regulated by bile acids, farnesoid X receptor (FXR), as well as other components of this pathway in human colorectal tumors and cell lines. The most significant changes were a decrease in FXR mRNA levels in adenomas (5-fold average) and carcinomas (10 fold average) and an increase in peroxisome proliferator activated receptor-gamma (2-fold average). FXR was not expressed in undifferentiated colon adenocarcinoma SW480 cells and metastasis derived SW620 cells. In Caco-2 and HT-29 cells, the level of FXR expression increased with the degree of differentiation. Intestinal bile acid binding protein was activated by chenodeoxycholic acid and the synthetic FXR agonist GW4064 in Caco-2 and HT-29 but not in SW cells unless FXR was transfected. The down-regulation of the nuclear receptor FXR in colon cancer might be of clinical and pharmacological importance.

ATP Binding Cassette Transporter 1↗
PubMed2002

Subtotal colectomy with primary ileorectostomy is effective for unlocalized, diverticular hemorrhage.

BACKGROUND: A large proportion of patients with acute colonic diverticular bleeding undergo emergency surgery without successful prior localization of the bleeding site. This study sought to determine the surgical techniques of choice for unlocalized, diverticular hemorrhage. METHODS: We reviewed the data on 42 consecutive patients (median age 76 years, range 44-91) with acute colonic diverticular bleeding operated on between November 1993 and December 2000. Mean follow-up was 4.1 years. RESULTS: Preoperative localization of the bleeding site was possible in six patients (14%), by colonoscopy in two and by angiography in four. Ten patients underwent segmental colectomy with primary anastomosis (5 "directed", 5 "blind") and 32 subtotal colectomy with primary ileorectostomy (1 "directed", 31 "blind"). Subtotal colectomy is the more extensive surgical procedure (longer resected bowel, greater blood loss), and although it was performed in older patients, there were no significant differences between segmental and subtotal colectomy with respect to operation time, morbidity, mortality, hospital stay, number of bowel movements, continence scores, rebleeding rate, or patient satisfaction. CONCLUSIONS: Subtotal colectomy with primary ileorectostomy for unlocalized colonic diverticular bleeding is a safe and effective surgical procedure providing complete bleeding control and preserving continence.

Adult↗
PubMed2002

Long-term survival of patients with stage IV hypopharyngeal cancer: impact of fundus rotation gastroplasty.

Stage IV circular hypopharyngeal cancer is a disease with poor long-term survival, and the only means of cure-surgery-is associated with high morbidity. All patients admitted with circular hypopharyngeal cancer and extension to the esophagus were enrolled in a multidisciplinary treatment protocol, including circular laryngopharyngoesophagectomy with tracheostomy, neck dissection, and pull-up of a fundus rotation gastric tube that was anastomosed to the oropharynx. Five weeks postoperatively high-dose radiotherapy (60 Gy) was given to the cervical region. Altogether, 18 qualifying patients were explored cervically, were found to have resectable lesions (i.e., without carotid artery infiltration), and were included in the protocol. After laryngopharyngoesophagectomy, an elongated gastric tube was pulled up to the oropharynx. The average distance bridged with the tube was 32 +/- 4 cm. No anastomotic leaks were found on postoperative Gastrografin swallow, and oral feeding was started between days 5 and 8. Patients were discharged with normal oral feeding on day 21 (+/- 17 days). Diarrhea, postprandial fullness, and reflux resolved within 6 months postoperatively. Five patients died during the follow-up period of 42 months (range 3-63 months): three due to cardiac events 18 and 38 months postoperatively and two within 12 months with residual disease and tumor recurrence, respectively. The estimated 5-year survival was 60%. We concluded that an aggressive multidisciplinary approach including circular laryngopharyngoesophagectomy, neck dissection, and high-dose radiotherapy ascertains good long-term survival and good functional results in patients with advanced hypopharyngeal cancer when the intestinal continuity is reconstructed with a fundus rotation gastroplasty.

Deglutition Disorders↗
PubMed2002

Acute radiation colitis in patients treated with short-term preoperative radiotherapy for rectal cancer.

The histopathologic features of acute radiation-induced colitis in humans have been described in occasional, >20-year-old studies, but they have not been analyzed in detail. We characterize such findings in 34 patients with rectal cancer who underwent surgery a few days after preoperative irradiation with 25 Gy given over 5-7 days, and we compare the results to the histopathologic features detected in 18 patients treated by a conventional preoperative irradiation protocol consisting of 45 Gy during 5 weeks followed by surgery after a time interval of at least 3 weeks. Short-term preoperative irradiation therapy generally induced severe mucosal inflammation characterized by increased cellularity of the lamina propria, prominent eosinophilic infiltrates, crypt disarray, surface and crypt epithelial damage, nuclear abnormalities, and presence of apoptotic bodies in the crypt epithelium. These histopathologic features were absent or detected only occasionally in the patient group treated according to the long-term preoperative irradiation protocol. Despite acute severe inflammation, none of the patients treated by short-term irradiation developed perioperative complications. These observations indicate that acute radiation colitis may remain clinically silent and resolve spontaneously within a few weeks after irradiation. Given the widening acceptance of short-term preoperative irradiation protocols for rectal cancer, pathologists should be aware of the rather characteristic histologic findings of acute radiation colitis and avoid unnecessary concern of clinicians. The differential diagnosis includes infectious colitis, collagenous and ischemic colitis, nonsteroidal anti-inflammatory drug-associated colitis, and chronic idiopathic inflammatory bowel disease.

Acute Disease↗
PubMed2002

Preoperative colonoscopic derotation is beneficial in acute colonic volvulus.

AIMS: Analysis of preoperative and operative management of acute colonic volvulus and development of treatment guidelines in a region of low incidence. METHODS: A study of 42 consecutive patients operated for acute colonic volvulus between 1970 and 2000. RESULTS: There were 20 patients with sigmoid volvulus, 21 with cecal volvulus and 1 with volvulus of the transverse colon. All patients presented as emergencies. The correct preoperative diagnosis was possible for sigmoid volvulus in 95% (19/20) of cases and for cecal volvulus in 67% (14/21). Preoperative colonoscopic volvulus derotation was attempted in 19 patients and successfully completed in 9 patients (47%). The success rates for preoperative colonoscopic derotation were 58 (7/12) and 33% (2/6) for sigmoid and cecal volvulus, respectively. Thirty-four patients (81%) underwent colon resections, 26 times as a single-stage procedure, and 8 patients (19%) underwent non-resectional operative techniques. Overall surgical morbidity was 24%, the reoperation rate 9.5% and mortality 12% (5/42). The subgroup of 9 patients with successful non-operative volvulus derotation, however, underwent semi-elective single-stage colonic resection without surgical morbidity or mortality. There were no recurrences during a median follow-up period of 9.5 years. CONCLUSION: In the absence of clinical, laboratory or radiological signs of bowel necrosis or perforation, colonoscopic volvulus derotation is recommended in all cases of acute colonic volvulus, followed by semi-elective single-stage colonic resection.

Acute Disease↗