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Biomedical subjects

D Liebermann-Meffert

Publications and source records attributed to D Liebermann-Meffert.

At least 19 recordsLinked to original sources
PubMed2001

Anatomical basis for the approach and extent of surgical treatment of esophageal cancer.

The surgical treatment of cancer of the esophagus includes esophagectomy, adequate radical lymphadenectomy, and esophageal reconstruction. Lymph node metastasis of esophageal cancer is the major factor that influences the prognosis after surgery. Even with an invasion depth limited to the mucosa or submucosa, the prognosis is remarkably poor compared with the same invasion depth in gastric or colorectal cancer. Superficial cancer of the esophagus may metastasize into lymph nodes far distant from the primary tumor, not only into the mediastinum but also into the neck and abdomen. Therefore, these cases require treatment of potentially widely distributed metastases and a safe construction of a viable intestinoesophageal conduit. Under the prevailing conditions, however, surgical interventions without fundamental knowledge of the structures of this area are unacceptable.

Esophageal Neoplasms↗
PubMed2000

II. Vinzenz Czerny (1842-1915): grand seigneur of oncologic surgery--life, influence, and work of the Second Congress President of the ISS/SIC. International Society of Surgery/Société Internationale de Chirurgie.

Vinzenz Czerny, chairman and professor of surgery in Freiburg im Breisgau and in Heidelberg, Germany, is the typical example of a prominent surgeon with an elegant technique, who was also a keen observer and scientist at the turn of the nineteenth into the early twentieth century. Starting his career in Vienna, Austria, he can be looked upon as the most important disciple of Theodor Billroth. Whereas Billroth may be regarded as the father of modern gastrointestinal surgery, Czerny can be considered the father of modern surgery for intestinal malignancies and multimodal treatment. The early history of visceral cancer therapy is linked with his career. He became a surgeon of the highest rank, with great clinical skill, rare judgment, and vision who contributed essentially to the development of modern surgery. From his early education he maintained a lifelong affection for the natural sciences and was an excellent physiologist and pathologist. During his professional life he successfully built up a well deserved reputation for general and cancer surgery and for the introduction of radio- and chemotherapy into the treatment of tumors. Czerny founded and chaired the first experimental Institute for Cancer Research in Germany. Two years later, in 1908, he presided at the 2nd Congress of the International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC) in Brussels, a congress that was almost entirely devoted to the etiology of visceral cancer and the progress and achievements of its treatment. Czerny left a clear legacy of opinion and methods on which the modern era of surgical cancer treatment is based.

General Surgery↗
PubMed2000

History of the International Society of Surgery/Société International de Chirurgie (ISS/SIC). I. Short story of Theodor Kocher's life and relationship to the International Society of Surgery.

With the aim of promoting progress in surgery through the friendly exchange of views and experience, the International Society of Surgery was founded in Brussels in 1902, thereby helping to overcome the narrow boundaries of that time's nationalism. At its first congress, the International Society of Surgery (ISS), otherwise known by its French name, Société Internationale de Chirurgie (SIC), already numbered 638 members, among them the most important surgeons from all over the world. Theodor Kocher (1841-1917) was the president of the first congress, held in Brussels in 1905, and was also responsible for the choice of topics. His presidential address clearly reflected the high aims the Society set for itself. Kocher's personal and professional authority, his surgical skill, which he liked so much to communicate to his colleagues, and his international thinking shaped the young Society. He remained on the international committee of the ISS until his death. Renowned surgeons from all over the globe traveled to Bern to see Kocher at work, among whom were many distinguished leaders of U.S. surgery. Thus Kocher's contribution had a great impact on the developing surgery, in particular in the United States. A short curriculum outlines the personality of this outstanding surgeon.

General Surgery↗
PubMed2000

The greater omentum. Anatomy, embryology, and surgical applications.

The significance of the greater omentum has been discovered recently by surgeons of various disciplines because it provides an excellent plastic material against inflammation and irradiation and for repair of defects that can be applied in the abdominal cavity; or it can be exteriorized and lengthened at a vascular pedicle and detached using microvascular anastomoses. Anatomic features, such as the volume of the omentum and the arrangement of the blood vessels, determine the lines of dissection. The eminent omental potential and the different biochemical and immunologic functions are unique, and can be related to specific anatomic structures, some of which may be drawn back to its embryologic sources. The ability of absorption and adhesion formation, neovascularization, and infection defense by the omentum protects against irradiation damage, accelerates healing of dead space, and improves the complication rate and quality of life after application to a wound bed.

Humans↗
PubMed1998

[Surgical anatomy of the esophagus and stomach in relation to stomach pull-through].

Surgical-anatomical related risks with respect to: 1. Resection of the esophagus: As long as the tumor is confined to the wall, there is no risk of bleeding because, close to the esophagus, all the vessels have become minute; when torn, hemostasis will occur. For the same reason the recurrent nerves are not endangered as long as the main trunk is not disrupted and the anastomosis not performed within the cranial 3-5 cm. 2. Substitute: Preservation of the gastroduodenal and superior mesenteric arteries is essential to supply the gastric tube via the gastroepiploic vessels. The fundus, i.e., the top of the tube in particular in gastroplasty procedures is extremely vulnerable to pressure and tension.

Anastomosis, Surgical↗
PubMed1997

Boerhaave's syndrome: analysis of the literature and report of 18 new cases.

Postemetic spontaneous rupture of the esophagus is an intrathoracic disaster which is generally lethal if untreated. The tragedy seems to strike more often than commonly suspected. The current literature review focuses on publications since 1980 and includes the retrospective review of 18 additional patients treated in our hospital for spontaneous rupture of the esophagus. Frequently, a wide variety of unspecific symptoms has led to the mistaken diagnosis of an acute abdomen, pancreatitis or cardiac arrest. About 40% of the patients with spontaneous rupture of the esophagus presented a history of alcoholism or heavy drinking and 41% suffered from gastroduodenal ulcer disease. Pain (83%) and vomiting (79%) often associated with dyspnea (39%) and shock (32%) are the major symptoms. This unspecific symptomatology delayed the correct diagnosis of the Boerhaave's syndrome and resulted in a significant complication rate. The mortality rate associated with Boerhaave's syndrome was 50% from the first successful surgical repair in 1947 by Barrett to 1980. After 1980, however, the mortality rate dropped to 31%, because of earlier diagnosis, surgical repair and improvement in intensive care. When surgery is delayed, the prognosis of patients with spontaneous rupture of the esophagus is in general severe.

Abdomen, Acute↗
PubMed1997

Gastroesophageal sphincter: a model.

There is substantial experimental and anatomic evidence suggesting that the human lower esophageal sphincter is not a muscular ring but has its correlate in the arrangement of the so-called muscular clasps and oblique sling fibers at the gastroesophageal junction. We assessed the mode of action of these distinct muscle units in a mechanical model. The arrangement of the clasp and sling fibers at the gastroesophageal junction was simulated with two elastic bands placed perpendicularly around the gastroesophageal junction of four pig specimens. Rapid pullback manometry with four radially oriented pressure transducers was performed in each specimen. The opening pressure was determined, and three-dimensional pressure images were constructed based on the manometric readings. The elastic bands established a competent high-pressure zone at the level of the gastroesophageal junction. The three-dimensional pressure images matched those usually observed in vivo in normal human volunteers. The vector volume of the high-pressure zone correlated with the opening pressure while individual resting pressure values and length of the high-pressure zone were not sufficient to estimate the competence of the gastroesophageal junction in the model. This model supports the contention that the combined action of the clasp and sling fibers establishes the manometric lower esophageal sphincter in humans.

Animals↗
PubMed1996

[The 100th birthday of Rudolf Nissen].

Rudolf Nissen was born in Neisse, Schlesien, 9 September 1896. From 1921 to 1933 he was the favorite pupil of Ferdinand Sauerbruch in Munich and Berlin. 1930 he became professor of surgery at the Charité. The assumption of power by the Nazi-regime forced Nissen to resign his position and end his career in Germany. He took over the surgical chair in Istanbul, Turkey. Emigrating in 1939 to the USA, he held surgical positions in hospitals at New York and accepted in 1952 the chair of Surgery at the University of Basel, Switzerland. Nissen died in Riehen/ Basel on 22 January 1981. Nissen was a critical observant clinician, an efficient and popular physician, a teacher and a speaker. Of historical significance are pioneering works in thoracic surgery, the first successful pneumectomy in man, the classical works about the treatment of gastro-oesophageal reflux disease and hiatus hernia. The Nissen-Rossetti type of fundoplication has remained the standard procedure in Europe and the USA.

Fundoplication↗
PubMed1995

Three-dimensional pressure image and muscular structure of the human lower esophageal sphincter.

BACKGROUND: The structural equivalent to the manometric high pressure zone separating the stomach from the esophagus is still a matter of dispute. We compared the three-dimensional (3D) manometric pressure image with muscular thickness and architecture at the human gastroesophageal junction. METHODS: Three-dimensional manometric images were obtained in 25 volunteers by using a stepwise pullback technique of a catheter with eight radially oriented pressure transducers. Muscle thickness was measured in four radial directions at 10 levels between the midesophagus and stomach in 37 specimens obtained from organ donors. Muscular architecture was assessed in specimens from 10 organ donors and 12 human cadavers and was related to muscle thickness. RESULTS: Manometric 3D images of the lower esophageal high pressure zone showed a marked radial and longitudinal asymmetry. Radial pressures peaked at the respiratory inversion point and were highest toward the left posterior direction. Anatomic evaluation showed an asymmetric thickening of the muscular layer at the gastroesophageal junction that mirrored the manometric image. Muscle thickness was highest toward the greater curvature side corresponding to the gastric "sling" fibers and toward the lesser curvature corresponding to the semicircular "clasp" fibers. CONCLUSIONS: The human lower esophageal sphincter is not a muscular ring. Rather, the perfect match between the manometric pressures and the arrangement of muscular structures at the gastroesophageal junction indicates that the gastric sling fibers and the semicircular clasps are the anatomic correlate of the manometric lower esophageal sphincter in human beings.

Adolescent↗
PubMed1995

Manometric vector volume analysis to assess lower esophageal sphincter function.

The resistance provided by the manometric high pressure zone at the gastroesophageal junction, is the major barrier against gastroesophageal reflux in man. Recent studies have shown that this high pressure zone has its correlate in the architecture of the gastric 'sling' fibres at the gastric notch and the semicircular 'clasps' at the lesser curvature side of the gastroesophageal junction. Pull-back manometry with radially oriented pressure transducers allows to assess these distinct components of the human lower esophageal sphincter. With the recent introduction of personal computers into the manometry laboratory, three-dimensional manometric images of the lower esophageal sphincter can be easily constructed, based on radially oriented pressures. The application of this new technology has shown that calculation of the sphincter pressure vector volume, i.e. the volume circumscribed by the three-dimensional manometric sphincter image, is superior to standard manometric techniques in the assessment of lower esophageal sphincter function. The sphincter pressure vector volume is a particularly helpful parameter to identify patients with gastroesophageal reflux disease who will not benefit from medical therapy and should consequently undergo early antireflux surgery. Vector volume analysis is also helpful in assessing the cause of recurrent symptoms in patients with previous antireflux surgery. In patients with achalasia three-dimensional sphincter imaging and vector volume analysis can illustrate a severely asymmetric and hypertensive sphincter and show the effect of myotomy with or without a concomitant antireflux procedure on the sphincter pressure profile.

Computer Graphics↗
PubMed1992

[Relations of Theodor Kocher with the "International Society of Surgery". His role as the 1st congress president].

With the aim of promoting progress in surgery through the friendly exchange of views and experience, the first International Society of Surgery was founded at Brussels in 1902, hereby helping to overcome the narrow boundaries of that times' nationalism. At its first congress, the "International Society of Surgery (ISS)", otherwise known by its French name "Société Internationale de Chirurgie (SIC)", numbered already 638 members, amongst them the most important surgeons from all over the world. Theodor Kocher was the president of the first congress, held at Brussels in 1905, and was also responsible for the choice of topics. His presidential address clearly reflected the high aims the Society set itself. Kocher's personal and professional authority, his surgical skill, which he liked so much to communicate to his colleagues, and his internationally minded thinking shaped the young society. He remained in the international committee of the ISS until his death in 1917.

Europe↗
PubMed1990

[An anatomic study of the pancreatic lymphatics. Review of the summary and an abridged version of the original text].

A detailed study of the lymphatics around the pancreas was carried out in order to provide a theoretic basis for ideal lymph-node resection in radical cancer operations. The following results were obtained as a result of minute macroscopic dissection of the lymphatics. Three major pathways are identified on the anterior surface of the head of the pancreas. The upper pathway belongs to the common hepatic group. The middle and lower routes are associated with the superior mesenteric nodal group. All these pathways terminate in the node situated to the right of the origins of the celiac trunk and the superior mesenteric artery. The lymphatics arising from the neck of the pancreas also converge at the same node. Behind this node, there is a terminal node for the lymphatics which arise from the posterior surface of the head. Both nodes are firmly adherent, with only the nerve plexus of the head of the pancreas intervening. In this study, we have named these lymph-nodes Lnn celiacomesenterici dextri superficialis et profundi. Two distinct pathways are identified in the left half of the pancreas. One follows the splenic blood vessels and the other accompanies the inferior pancreatic artery. By way of these routes, lymphatics from the left half of the pancreas terminate in the node situated to the left of the origins of the celiac trunk and superior mesenteric artery. We have applied the term Ln celiacomesentericus sinister to this node.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1989

[What does the omentum plug accomplish in colorectal tumor surgery? A 10-year follow-up].

In 23 of 47 patients who underwent surgery for malignant colorectal tumors between January 1978 and December 1986, the residual cavity was treated with a pedicled omental plug after radical resection of the tumor-bearing areas. There was advanced transmural tumor spread in 13 omentum patients and in 9 operated without using omentum. The other patients had equally distributed T2 and T3 stage tumors. Complications were similar in both groups, but perineal infection was slightly less frequent and less significant in the omentum group. Hospitalization was 23 days in patients with the omental plug and 34 days in the others. Life quality, as shown by the activity index, was better in the omentum group. 30-day postoperative mortality was 8.5% in both groups. Individual survival after surgery was 23 months with the omental plug, compared with 15 months in patients without this procedure. At 5 years, however, survival rate was similar. Postmortem revealed no tumor spread alongside the transposed omentum, which had changed to a mesentery-like structure. From these results it is clear that the omentum plug does not achieve cure in carcinoma or longterm survival, but improves the complication rate and individual survival time. We can therefore recommend this procedure as palliative treatment, since even extensive defects can be covered effectively by omentum.

Adult↗
PubMed1988

[Intestino-esophageal reflux following gastrectomy. Mechanism of action and effectiveness of esophago-jejunoplication].

The influence of the type of reconstruction after gastrectomy upon the postoperative reflux was analyzed in 30 patients. The refluxed material could be directly gained by the long-term reflux aspiration test and, thus, the quality including bile acids could be evaluated. After esophago-jejunoplication and Roux en Y-derivation 5 out of 7 patients were asymptomatic; only one patient suffered from mild esophagitis. Total bile acid concentration was near to the test systems sensitivity. The result in 11 patients after esophago-jejunostomy without Y-en Roux, but with a preserved lower esophageal sphincter (LES) are similar to the former group, whereas in all cases of 12 patients in whom the LES was resected, severe reflux esophagitis and excessively elevated bile acid concentrations were present. These results confirm that a jejunoplication supports the antireflux effect of preserved parts of the LES. If--for oncologic reasons--the LES has to be resected, free intestinal-esophageal reflux is following. In these cases a Roux en Y-derivation is required.

Adult↗