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Biomedical subjects

F Stelzner

Publications and source records attributed to F Stelzner.

At least 19 recordsLinked to original sources
PubMed1992

[Sequential cancer of concomitant cancer?].

The generally-favoured polyp-cancer sequence hypothesis its probably wrong. The distribution of polyps in large intestine differs from that of cancer. There is evidence that different aetiological factors are involved in the genesis of polyps, their growth rate and the development to invasive cancer. Most polyps are very small (90%). They never develop a cancer. It is a diffusely abnormal state of the large bowel mucosa which renders it more liable to produce often polyps and very rare carcinoma (5%). Polyp-carcinoma concomitance is much nearer to the truth.

Cell Transformation, Neoplastic↗
PubMed1992

[Anatomically-induced diagnostic and technical surgical problems and complications in surgery of the anorectum].

Preservation and reconstruction are the key principles for surgical therapy of the anorectal organ of continence. The occlusive strength of the sphincter system varies significantly among individuals. As a rule, women have weaker sphincter muscles than men. Both sexes experience a decrease in sphincter strength with age. The physiological weakness of the anorectal sphincters in females is explained by a relatively smaller amount of sphincter muscle mass and an asymmetric sphincter anatomy which is characteristic for the female pelvic floor. In addition, the spinal centers controlling continence are structurally less complex in women than in men. Chronic constipation and the stress of vaginal deliveries frequently cause damage to the pelvic floor in women by overstretching muscular elements. They appear to play a leading role in the development of spontaneous incontinence, a condition occurring exclusively in women. Preoperative assessment of sphincter strength can be accomplished easily by using a very simple measuring device described earlier. Sphincter pressure measurements are felt to be an essential part of any preoperative work-up in anorectal surgery. The numerous procedures described for reconstructing anorectal sphincter function in patients with incontinence are symbolic operations which at the most create an illusion of continence. Narrowing the levator muscles with plastic bands may improve continence if there is some residual sphincter musculature which is still functional. But it will never cure anorectal incontinence. Recommendable procedures for treatment of anorectal prolaps, anorectal fistulas, and hemorrhoids are discussed. Operative treatment of hemorrhoids which are caused by hyperplastic enlargement of parts of the corpus cavernosum recti is also associated with a greater risk of incontinence in women than in men.

Aged↗
PubMed1992

[Foundation, technique and results of short continence resection in rectal cancer].

Ultra-short resections of the rectum have been recommended for rectal carcinomas extending to lower than eight cm from the dentate line in order to preserve anal continence. Resection of the main lymphatic pathways together with the adjacent lamellae is important for radical removal of all tumour cells. Valves in the rectal lymph vessels allow lymph fluids to drain only in a cranial direction. There are no lymph nodes behind the dorsal adjacent lamella. Thus, a distal margin of two cm from the tumour is sufficient to minimize the risk of recurrence. We recommend a transano-abdominal approach for very low rectal carcinomas. During the past years, we have operated on 241 patients with rectal carcinomas and found five-year-survival rates of 54 percent with rectum resections with colostomies, 67 percent with low anterior resections and 75% with ultra-short sphincter preserving resections.

Anastomosis, Surgical↗
PubMed1992

[Hemorrhoidectomy--a simple operation? Incontinence, stenosis, fistula, infection and fatalities].

Hemorrhoidectomy is not a simple procedure. Hemorrhoids develop as hyperplastic formations of an important part of the anorectal organ of continence, i.e., the corpus cavernosum recti. This organ segment is analogous to tissue structures found in the tongue of certain birds which are used for hulling seeds. Well-meaning, complete resection of the corpus cavernosum will inevitably result in incontinence. Only operative techniques which resect exclusively those segments of the hemorrhoidal tissue adjacent to the muscle layer in the anal canal are adequate. These procedures will spare sufficient tissue of the corpus cavernosum to allow a safe segmental resection of this structure and at the same time permanently eradicate the hemorrhoids. In the present paper, the treatment of 53 patients with postoperative incontinence and of others with stenoses, fistulas and pelvic infections is discussed. Fatalities have never been reported in the literature following operative hemorrhoidectomy, however, have occurred after "banding" procedures and after injection therapy.

Adult↗
PubMed1991

[Fascia skeleton of the abdominal cavity--hernia and anorectal incontinence].

The abdominal cavity is the most primitive body cavity. Its musculo-fascial skeleton encompasses the abdominal wall, the pelvic floor, and the diaphragm. Comparative anatomical studies have demonstrated remarkable homology in the muscular and fascial architecture of each of these structures. In addition, all muscular sheets lining the abdominal cavity display a characteristic resting tone enabling them to act as a single functional unit. During pregnancy and childbirth the abdominal wall and the pelvic floor are prone to impairment from overstretching. This damage may result in postpartum paralysis of the abdominal wall or anorectal incontinence. Insight in the special anatomic and physiologic features of the abdominal muscle sheets may lead to a better understanding of the pathogenesis of primary and secondary abdominal hernias as well as postpartum anorectal incontinence and may improve surgical treatment.

Abdominal Muscles↗
PubMed1991

[Conservative surgery].

Today the potentially dangerous aftereffects of surgical procedures such as shock or wound infection can be effectively prevented. The use of dissection technique which minimizes trauma to the surrounding tissues by means of a scalpel or electrocautery reduces the general impact of an operation. The use of atraumatic needles and modern, synthetic suture materials have decreased the incidence of wound infections significantly. Dissection along avascular fascial planes such as the adjacent lamellae allows the removal of large volumes of tissue without sequelae. Adjacent lamellae are special fasciae which enclose organs protectively.

Anastomosis, Surgical↗
PubMed1991

[Anorectal incontinence--cause and treatment].

The organ of continence shows sex-related differences. The female organ of continence is less high developed and therefore more susceptible to impairment. 90% of all patients with "spontaneous incontinence" are women. This can be explained by comparative anatomy. Pelvic floor and abdominal wall is a unit. They have an intrinsic permanent tone and this is on the pelvic floor the basis of continence. During delivery and from chronic obstipation pelvic nerve damage due to overextension occur frequently. The permanent tone is lost. The flabby abdomen and incontinence are therefore the result of such nerve overextension injuries. Our results of treatment in 120 patients are very good in traumatic lesions by direct sphincter suture. If the pelvic floor has retained some of its strength a circular silastic band can improve the effect of continence.

Anal Canal↗
PubMed1990

[Complex trauma of the perineum, especially the anorectal continence organ. Experiences and results in 27 patients 1956-1988].

This report is based upon 27 patients with severe perineal injuries treated in a 30-year-period. Four groups of injuries could be identified. Severity of the trauma, correct diagnosis of concomitant injuries, right usage of antibiotics and protection of the perineal wound by a temporary colostomy represented key factors for a favorable outcome. There is evidence from our data that primary repair should be carried out immediately for tears of the anorectal sphincter. Even if the organ of continence as a whole is separated from the pelvic floor, good functional results can thus be achieved. Extensive scar formation must be prevented as secondary sphincter reconstruction (gracilis muscle transposition) was never successful in our patients. All these cases required a permanent colostomy. Concomitant tears of the membranous urethra frequently caused urethral stenoses and irreversible impotence. Mortality rates were low in patients with severe perineal injuries.

Adult↗
PubMed1990

[May the internal iliac artery in the pelvic area be ligated in situ bilaterally for hemostasis? Indications and contraindications].

The bilateral ligation of the internal iliac arteries in situ is successful in preventing haemostasis and the treatment of potentially lethal haemorrhage. In spite of using a resorbable thread (catgut) for ligation a complete recanalization of this large artery could only be observed after nine months in an animal experiment. Clinically this ligation of the artery in situ without severance has not impaired erective potency in patients with an otherwise healthy vascular system. Since many patients did not show any disturbance prior to the vessel's recanalization the early established parallel circulation is sufficient to compensate for the perfusion deficit. A contraindication for the ligation is a previous major procedure, especially, in cases of irradiation or an occlusive vascular disease.

Adult↗
PubMed1990

[Results of treatment of anal cancer].

Symptoms, results of therapy as well as prognosis of carcinoma of the anal canal and anal margin are analyzed in 37 own patients, treated within 1977 and 1988. Most of the patients were between 55 and 75 years old. Women (n = 24) were twice as often afflicted as men. Bleedings and pain were the most frequent symptoms. At the end of this study 25 (71%) of the registered patients were still alive, 12 (34%) of them for more than 5 years. Different therapeutical procedures had been applied. Because of the own results the value of radical abdomino-perineal rectum amputation is stressed for invasive cancers, relapses and rest cancer after preceding adjuvant therapy. Multimodal treatment strategy with combined radiation-chemotherapy and individually adapted surgery is performed according to the literature. Valid results of the value of this procedure in our own patients however can not be given at the present time.

Adult↗
PubMed1989

[Anatomical basis, technic and results of narrow transanoabdominal continence resection].

Ultrashort resections of the rectum have been recommended for rectal carcinomas extending below eight cm from the dentate line in order to preserve anal continence. Resection of the main lymphatic pathways together with the adjacent lamellae is important for radical removal of all tumor cells. Valves in the rectal lymph vessels allow lymph fluids to drain only in a cranial direction. There are no lymph nodes below the dorsal adjacent lamella. Thus, a distal margin of two cm from the tumor is sufficient to minimize the risk of recurrence. We recommend a trans-ano-abdominal approach for very low rectal carcinomas. During the past years, we have operated on 156 patients with rectal carcinomas and found five-year-survival rates of 50 percent with rectum resections with colostomies, 62 percent with low anterior resections and 69% with ultra-short sphincter-preserving resections.

Anal Canal↗
PubMed1989

[Principles, technique and results of short continence resection].

Ultra-short resections of the rectum have been recommended for rectal carcinomas that extend less than 8 cm above the dentate line in order to preserve anal continence. Resection of the main lymphatic pathways together with the adjacent lamellae is important. Valves in the rectal lymph vessels allow lymph fluid to drain only cranially. There are no lymph nodes behind the dorsal adjacent lamella. We recommend a transano-abdominal approach. A five-year survival rate of 50% was found in 156 patients with rectal carcinomas who underwent rectal resections and colostomies, 62% in those receiving low anterior resections and 69% in those with ultra-short sphincter-preserving resections.

Fecal Incontinence↗
PubMed1989

[Diagnosis and treatment of anal fistula].

Anorectal fistulas can only be cured by operative treatment based on a thorough knowledge of anal anatomy. Recurrences are frequently a result of the surgeon's failure to expose the entire fistula tract out of fear of impaining anal continence. Surgery can provide a permanent cure in 95% of all such cases. Curative treatment of fistulas in patients with colitis, Crohn's disease or AIDS may not be feasible, but some improvement can be achieved. Anal sphincter function should be measured prior to surgery. The anal sphincter is always stronger in males than in females, who are more likely to experience permanent damage of anal continence. This is also true for patients with recurrent disease. Some cases of complicated fistulas are reported.

Abscess↗
PubMed1989

[The surgical anatomy of the genital nerves of the male and their preservation in excision of the rectum].

Studies of the fetus and new-born were undertaken to determine the exact localization of the nn. erigentes in the lower pelvis. The particular topography was visualized using histological slides and a special digital imaging technique. The nn. erigentes were found to be bundled along the diaphragmatic part of the urethra before entering the two cavernous bodies of the penis. These findings suggest that a small anterior patch of rectal muscle covering the diaphragmatic part of the urethra should be left behind in male patients undergoing total proctocolectomy in order to preserve potency. This operative technique cannot be employed for carcinomas extending to the anterior rectal wall. Since 1980, the new technique has been used in 18 male patients with rectal carcinoma and sexual function was preserved in all cases.

Adult↗
PubMed1979

[Early diagnosis of ileus by the gastrointestinal passage of a resorbable contrast medium and of recurrent intestinal obstruction].

The differential diagnosis of paralytic ileus vs mechanical intestinal obstruction using Gastrografin is a useful method because a correct decision can be made for or against surgery in doubtful cases. Gastrografin is a valuable diagnostic aid in cases with pseudo-obstruction since recurrent obstruction often seems to be a pseudo-obstruction. We doubt if a recurrent obstruction should be treated by any method of intestinopexy.

Adult↗