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Biomedical subjects

G Arlt

Publications and source records attributed to G Arlt.

At least 19 recordsLinked to original sources
PubMed2005

Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair.

BACKGROUND: Polymer mesh has been used to repair incisional hernias with lower recurrence rates than suture repair. A new generation of mesh has been developed with reduced polypropylene mass and increased pore size. The aim of this study was to compare standard mesh with new lightweight mesh in patients undergoing incisional hernia repair. METHODS: Patients were randomized to receive lightweight composite mesh, or standard polyester or polypropylene mesh. Outcomes were evaluated at 21 days, 4, 12 and 24 months from patient responses to the Short Form 36 (SF-36) and daily activity questionnaires. Complications and recurrence rates were recorded. RESULTS: A total of 165 patients were included in an intention-to-treat analysis (83 lightweight mesh, 82 standard mesh). Postoperative complication rates were similar. The overall hernia recurrence rate was 17 per cent with the lightweight mesh versus 7 per cent with the standard mesh (P = 0.052). There were no differences in SF-36 physical function scores or daily activities between 21 days and 24 months after surgery. CONCLUSION: The use of the lightweight composite mesh for incisional hernia repair had similar outcomes to polypropylene or polyester mesh with the exception of a non-significant trend towards increased hernia recurrence. The latter may be related to technical factors with regard to the specific placement and fixation requirements of lightweight composite mesh.

Activities of Daily Living↗
PubMed2002

[The Shouldice repair for inguinal hernia--technique and results].

The technique of the Shouldice hernioplasty for primary and recurrent inguinal hernia is described on the basis of more than 3 500 procedures at the Surgical University Clinic of Aachen and 700 operations performed at the Surgical Department of the Park-Klinik Berlin-Weissensee. Local anesthesia is the preferred type of anesthesia with a good acceptance by the patients site (96 %). In compliant adults nearly all primary and about 50 % of the recurrent hernias can be repaired under local anesthesia. Essentials of the preparative phase are identification and preservation of the inguinal nerves, resection of the cremaster muscle and exposure of all three hernial sites (lateral, medial and femoral). For all primary hernias and indirect or small recurrent hernias a modified two-layer Shouldice repair of the transversalis fascia using a monofilament running suture (Polypropylene 0) is recommended. In the early postoperative period the physical activity is limited only by the patients complaints. Normal activity is gained back within 2 to 3 weeks. In a non selected group of patients 10-years recurrence rates are 2.6 % in primary hernia and 6.9 % in recurrent repair. The Shouldice repair is recommended as the procedure of choice for all primary and selected recurrent hernia. A mesh prosthesis may be necessary in large medial and combined recurrent hernia.

Adult↗
PubMed2000

Electrophysiological and mechanical activity of the upper gastrointestinal tract after duodenoplasty or segmental resection of benign gastric outlet stenosis.

In an animal experimental study we examined the postoperative recovery of the motility of the upper gastrointestinal tract after operative treatment of a benign gastric outlet obstruction. At 45 Days after induction, a duodenal stenosis was resected in six dogs, and resolved by Finney's duodenoplasty in another six dogs. Fourteen days after segmental resection, the gastric emptying was faster [half evacuation time (T1/2) for semisolid food = 44.4 +/- 16.8 min] than following duodenoplasty [T1/2 = 56.8 +/- 25.3). Here motor migrating complexes (MMCs) started in the antrum and could be traced down to the jejunum. After segmental resection we recognized MMC only distal to the anastomosis. The duration of the whole MMC cycle (69.0 +/- 18.6 min) as well as of the single phases was significantly shorter in the resection group than after duodenoplasty (108.0 +/- 15.1 min). At 28 days after operation the differences in the electromyographic findings were smaller (82.0 +/- 15.1 min vs. 111.4 +/- 11.2 min), but still significant. Obviously humoral transmitters and the extrinsic neural system lead to good propagation of the MMC across the anastomosis, even before the intramural pathways are reestablished. Concerning the fast recovery of the motility of the upper gastrointestinal tract, duodenoplasty is superior to segmental duodenal resection.

Animals↗
PubMed1999

Experimental studies on small intestinal pouch motility and evacuation.

UNLABELLED: The aim of the study was to investigate pouch motility and evacuation under standardised conditions with a minimum of external influence. METHODS: Ileal J-pouches had been constructed 30 cm proximal to the ileocecal valve in 10 dogs (6 pelvic/4 gastric configuration). After 8 weeks the following examinations were performed: (1) measurement of pouch compliance by balloon distension, (2) measurement of pouch contractions by strain gauge transducers, (3) radiological imaging of pouch contractions and evacuation, (4) evacuation scintigraphy and (5) radiological determination of small intestinal transit time. RESULTS: Compliance (2.3 +/- 1.1 mmHg/ml) and small intestinal transit time (31.6 +/- 7.5 h) were significantly higher in the pouch group than in controls (0.5 +/- 0.2 mmHg/ml, 8.0 +/- 2.8 h; p < 0.05). Scintigraphy and radiography showed delayed pouch evacuation (t(1/2) = 109 +/- 52 min). Strain gauge measurements revealed irregular pouch contractions without detectable propagation. Contraction amplitudes (40.4 +/- 22.9 g) and frequencies (10.4 +/- 1.0/min) were equal all over the pouch. There were no functional differences between gastric and pelvic pouch configuration. CONCLUSION: Small intestinal pouches act as reservoirs. Uncoordinated motility patterns contribute to this function. Other factors than pouch motility are responsible for evacuation.

Animals↗
PubMed1998

[Surgery of inguinal hernia with local anesthesia--technique and results of a minimal invasive procedure].

In three prospective, randomized studies we analyzed the advantages of local anesthesia in patients with primary inguinal hernias. Each study consisted of 100 cooperative adults, using an open approach and the transinguinal procedure. Due to reduced postoperative complications, increased effectiveness of hospital resources, earlier discharges and a high acceptance by the patients, local anesthesia is the ideal treatment in adult hernia repair.

Adult↗
PubMed1997

[Transinguinal preperitoneal mesh-plasty (TIPP) in management of recurrent inguinal hernia].

From 3 years' experience with nearly 100 transinguinal preperitoneal mesh prosthesis (TIPP) repairs for recurrent inguinal hernia the indication, anesthesia, modification of the technique, and results are reported. After intraoperative classification of the hernia, the TIPP repair is indicated especially in large defects of the posterior wall (L/M III). The procedure is easily performed under local anesthesia. During 52 local TIPP repairs, conversion of anesthesia was never necessary. Important technical details include the requirement for a sufficient size of mesh (10 cm x 15 cm) and a certain caudal and cranial fixation of the prosthesis using at least three interrupted stitches for each. Apart from an increased number of seromas (12%) in the early postoperative period, the results of the TIPP are comparable with those obtained after Shouldice repair for recurrent hernia. The rate of hematomas, infections, and testicular complications range between 1% and 3%. Considering the negative case selection of only large recurrent hernias, the TIPP repair reveals a favourably low 1-year recurrence rate of 1%.

Adult↗
PubMed1997

[Chronic inguinal pain after transperitoneal mesh implantation. Case report of net shrinkage].

The implantation of a mesh is an essential step in laparoscopic inguinal hernia surgery. We present the case of a 22-year-old man who developed an unspecific and refractory syndrome of inguinal pain after a TAPP procedure for a primary inguinal hernia. Repeated reoperation for removement of clips and nerve transection were unsuccessful. By a transinguinal approach, 18 months after the first operation we removed a preperitoneal Prolene mesh which had shrunk and folded to 30% of its original size. The problem of biocompatibility of meshes currently used in inguinal hernia surgery is discussed.

Adult↗
PubMed1997

[Artificial pressure increase in subcutaneous abscess with evidence of general systemic reaction].

Abscess is customarily thought of as a collection of a large number of microorganisms, inflammatory cells and necrotic debris separated from the surrounding tissue by a fibrous capsule. Modern work focussed attention on more physico-chemical parameters in abscess pathogenesis. Recent experiences from animal models underline the impact of abscess pressure and bio-physicochemical parameters in the "abscess compartment" for systemic spreading. Artificial raising of abscess-pressure in pigs up to 80 mmHg was followed by increase of temperature and heartbeat rate and decrease of median arterial pressure. Elevated levels of TNF alpha, IL-1 and positive blood cultures support the theory of abscess pressure as a most important variable in abscess formation. We conclude that abscess pressure may play a pivotal role in systemic spreading of the primarily localized process.

Abscess↗
PubMed1996

[Transinguinal preperitoneal mesh-plasty in inguinal hernia using local anesthesia].

Between January 1994 and December 1995 inguinal and femoral hernias were repaired in 689 adults. In 58 patients (4 primary hernias, 54 recurrent hernias, 1st-7th recurrence) a mesh prosthesis (Marlex) was implanted in the preperitoneal space using an open inguinal approach (TIPP). After intraoperative classification of the hernia, the indications for TIPP were L/M/Mc and F III type hernias and a weak or destroyed transverse fascia. The operative technique of TIPP is described in detail. Half of the procedures were done with the patient under local anesthesia. There were no intraoperative complications. Besides an increased number of seromas the postoperative course following TIPP was comparable with that after Shouldice procedures performed in the same period. During a follow-up period of 3-24 months to date, no recurrence has been observed. If intraoperative hernia classification is performed, TIPP is an appropriate technique for recurrence-prone inguinal and femoral hernias.

Adolescent↗
PubMed1995

[Endoscopic emergency therapy and early elective operation of at risk bleeding types in gastroduodenal ulcer hemorrhage--a prospective study].

253 consecutive patients with bleeding gastroduodenal ulcers were treated in a prospective protocol from Jan/1986 to Dec/1993. All underwent emergency endoscopy and injection therapy. In ulcers with a high risk of rebleeding (Forrest Ia, Ib, and IIvisible vessel) we performed an early elective operation (n = 126). Operative mortality was 9% (11/126). No patient died after endoscopic treatment, therefore the over-all mortality was 4% (11/253).

Aged↗
PubMed1994

Juvenile form of mucopolysaccharidosis VI (Maroteaux-Lamy syndrome). A C-terminal extension causes instability but increases catalytic efficiency of arylsulfatase B.

A deficiency of the enzyme arylsulfatase B results in the lysosomal storage disorder Maroteaux-Lamy syndrome or mucopolysaccharidosis type VI. Severe, intermediate and mild forms of this autosomal recessively inherited disease can be clinically differentiated. To determine the molecular defect in a patient with the intermediate form of the disorder, DNA fragments generated from the patient's mRNA by reverse transcription and subsequent amplification by the polymerase chain reaction were subcloned and sequenced. The mRNA transcribed from one allele contains a 244-base pair deletion causing a frameshift and a truncation of the open reading frame. The C-terminal third of the encoded mutant polypeptide has a nonsense sequence. This mutation is due to a deletion of exon 5 in this allele. A silent A to G transition at nucleotide 1191 was present in the same allele, and the second allele was characterized by a T to C transition at nucleotide 1600 causing a mutation of the translational stop codon to a glutamine codon (*534Q) and extending the encoded polypeptide by 50 amino acids. Stable expression of the *534Q allele in LTK- cells resulted in a mutant precursor 4 kDa larger than the wild-type precursor. The majority of the mutant precursor appears to be degraded before reaching the trans Golgi. This is consistent with an altered polypeptide structure, where a number of missing or masked epitopes were observed in an enzyme immunobinding assay using a panel of monoclonal antibodies. Immunoquantification analysis showed that epitopes were most likely masked, as missing epitopes could be reformed by binding the mutant protein to a polyclonal antibody of arylsulfatase B. It is suggested that the additional amino acids at the C terminus of the arylsulfatase B polypeptide induce a protein conformational change. *534Q mutant polypeptide escaping degradation is sorted to dense lysosomes. The mutant polypeptide has an approximately 9-fold higher catalytic efficiency than wild-type arylsulfatase B.

Alleles↗
PubMed1994

[Classification of inguinal hernias].

Classification of inguinal hernia is a necessary prerequisite for a reliable analysis of different methods of repair. The underlying categorization is done intraoperatively based on the localization ('M' medial, 'L' lateral, 'F' femoral) and transverse diameter (I = < 1.5 cm, II = 1.5-3.0 cm, III = > 3.0 cm) of the hernial orifice. In cases of combined hernias the diameters of both fascial defects is added up, the hernia is classified according to the part of major importance for the development of recurrences, the medial defect, with the index 'c'. The classification can be applied to open as well as laparoscopic approaches. The diameters of the tip of the index finger or the length of branch of endoscopic scissors (1.5 cm), respectively, serve as standards for measurement.

Fasciotomy↗
PubMed1994

[Anastomotic ulcers after duodenopancreatectomy for carcinoma of the head of the pancreas].

Anastomotic ulceration following partial pancreatoduodenectomy carries a substantial risk of complications. More than 50% of patients have episodes of bleeding and up to 20% die as a direct consequence of peptic complications. In a retrospective study of 88 patients, frequency of ulcer was analysed comparing Whipple-Child reconstruction and partial pancreatoduodenectomy with a Roux-Y gastrojejunostomy. Indication was ductal carcinoma of the pancreas in 80 cases and periampullary carcinoma in eight patients. Roux-Y gastrojejunostomy was performed in 53 cases, Billroth-II anastomosis with enteroanastomosis in 35 patients. Perioperative mortality was 7% (n = 6). Nine cases of anastomotic ulceration were verified after Roux-Y gastrojejunostomy (18%). Three out of five Roux patients with a periampullary carcinoma developed ulcers. After Billroth-II reconstruction anastomotic ulceration was found in only one out of 33 cases (3%). Six ulcers presented with bleeding, anastomotic stenosis occurred in two cases. Three ulcer patients with curatively resected periampullary carcinoma were reoperated. After resection of the Roux limb and truncal vagotomy no recurrence was seen during a follow-up period of 19 to 46 months. Roux-Y gastrojejunostomy carries an increased risk of anastomotic ulceration. The lack of inactivation of pepsin by bile acids has to be discussed as an underlying mechanism.

Adenocarcinoma↗
PubMed1994

Mucopolysaccharidosis VI (Maroteaux-Lamy syndrome): six unique arylsulfatase B gene alleles causing variable disease phenotypes.

Mucopolysaccharidosis type VI, or Maroteaux-Lamy syndrome, is a lysosomal storage disorder caused by a deficiency of the enzyme arylsulfatase B (ASB), also known as N-acetylgalactosamine-4-sulfatase. Multiple clinical phenotypes of this autosomal recessively inherited disease have been described. Recent isolation and characterization of the human ASB gene facilitated the analysis of molecular defects underlying the different phenotypes. Conditions for PCR amplification of the entire open reading frame from genomic DNA and for subsequent direct automated DNA sequencing of the resulting DNA fragments were established. Besides two polymorphisms described elsewhere that cause methionine-for-valine substitutions in the arylsulfatase B gene, six new mutations in six patients were detected: four point mutations resulting in amino acid substitutions, a 1-bp deletion, and a 1-bp insertion. The point mutations were two G-to-A and two T-to-C transitions. The G-to-A transitions cause an arginine-for-glycine substitution at residue 144 in a homoallelic patient with a severe disease phenotype and a tyrosine-for-cysteine substitution at residue 521 in a potentially heteroallelic patient with the severe form of the disease. The T-to-C transitions cause an arginine-for-cysteine substitution at amino acid residue 192 in a homoallelic patient with mild symptoms and a proline-for-leucine substitution at amino acid 321 in a homoallelic patient with the intermediate form. The insertion between nucleotides T1284 and G1285 resulted in a loss of the 100 C-terminal amino acids of the wild-type protein and in the deletion of nucleotide C1577 in a 39-amino-acid C-terminal extension of the ASB polypeptide. Both mutations were detected in homoallelic patients with the severe form of the disease. Expression of mutant cDNAs encoding the four amino acid substitutions and the deletion resulted in severe reduction of both ASB protein levels and arylsulfatase enzyme activity in comparison with a wild-type control. The six mutations described in the present study were unique among 25 unrelated mucopolysaccharidosis VI patients, suggesting a broad molecular heterogeneity of the Maroteaux-Lamy syndrome.

Alleles↗
PubMed1993

[Animal experiment studies of treatment of benign anastomotic stenosis of the colorectal area by electro-incision and balloon dilatation].

In an experimental study the significance of local electroincision and pressure in endoscopic dilatation therapy of benign colorectal anastomotic stenosis was investigated. A benign anastomotic stenosis was induced in the proximal part of the rectum in 21 pigs and was quantified and classified 12 weeks postoperatively using the stenosis index of McAdam. All stenotic anastomoses were dilated using electroincision (two incisions versus four) and balloon dilatation (230 mmHg versus 460 mmHg). Neither perforation nor severe bleeding occurred in any of the animals. At 24 weeks after the operation the anastomoses were restaged. We found significantly better results after four incisions than after two. After multiple incisions the dilation pressure was of secondary importance. Combined therapy with multiple incisions and balloon dilatation is a safe procedure yielding good results even with low-pressure dilatation.

Anastomosis, Surgical↗