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Biomedical subjects

G Arlt

Publications and source records attributed to G Arlt.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Billroth I hemigastrectomy in complicated recurrent ulcer after selective proximal vagotomy].

The outcome of Billroth I hemigastrectomy for complicated recurrent ulcers after proximal selective vagotomy (PSV) for duodenal ulcer was analyzed in a retrospective study of 15 patients followed up for 15-81 months (mean 3.8 years) postoperatively. Bleeding was reported in 4, stenosis in 5, penetration in 3, perforation in 1 and refractory ulcer in 2 cases. None of the patients died during revision surgery, and none developed ulcer recurrence. In 4 patients complications were seen, including bleeding requiring relaparotomy (1) and subhepatic hematoma (3). In 12 patients (80%) a good or excellent result (Visick I/II) was seen at follow-up. Reasons for Visick III or Visick IV classification were reflux esophagitis grades I and II in 2 cases and refractory dyspeptic symptoms in 1 case. Distal gastric resection with a Billroth I anastomosis for complicated recurrent ulcer after PSV proved to involve only low morbidity and to effect reliable prophylaxis of ulcer recurrence in the long term.

Adolescent↗
PubMed1992

[Endoscopic therapy of benign anastomotic stenoses in the area of the colon and rectum by electro-incision and balloon dilatation].

21 patients with a severe anastomotic stenosis in the colorectal region were treated with hydraulic balloon dilatation and endoscopic electro-incision. The severity of symptoms directly correlates with the extent of stenosis (degree I phi 13 mm, n = 12; degree II phi 7 mm, n = 6; degree III phi 4 mm, n = 3). All patients with a stenosis of degree I and II were symptom-free after the endoscopic therapy. In 2 of 3 cases the symptoms of stenosis of degree III could clinically be improved after the treatment. The average frequency of dilatation was 1.5 x, complications such as bleeding or perforation were not registered. Animal studies explain anastomotic stenosis through an increased submucosal formation of collagen fibers followed by formation of scars in the anastomosis. The efficiency of electro-incision and balloon dilatation is based on an increased diameter in the anastomotic region without increased formation of new collagen fibers.

Adult↗
PubMed1992

[Importance of sonography in diagnosis of ileus. A retrospective study of 459 patients].

In a retrospective trial we investigated the significance of ultrasound in the diagnosis of intestinal obstruction in 459 patients. The overall sensitivity was 93.7%. In paralysis the correct diagnosis was obtained in 98% of all. Mechanical obstruction was identified in 91%. In cases of incomplete mechanical obstruction sensitivity was 89%. The corresponding value for complete obstruction was 95%. In all patients with negative findings on abdominal x-ray (10%) the correct diagnosis was established by ultrasound. Only in 71% of cases ultrasound was successful differentiating small bowel from large bowel obstruction. The underlying cause of ileus was yielded by ultrasound in 45% of the cases. On the basis of our experience ultrasound is proven to be of significant importance in the diagnosis and differentiation of ileus.

Adolescent↗
PubMed1990

[Increased bile acid retention in biliodigestive Roux-Y anastomosis in animal experiment].

In an experimental study on 65 rats the influence of different Roux-Y biliary anastomoses on the enterohepatic bile acid circulation was investigated. Long (10 cm) and short (3 cm) isoperistaltic and long (10 cm) anisoperistaltic Roux-Y loops were studied and compared to sham-operated controls. 75-SeHCAT a y-labeled synthetic bile acid was used for assessment of enterohepatic circulation. Hepatic excretion and enteric bile flow was investigated by 99m-Tc-HIDA. Intestinal transit time was evaluated by 51-Cr-EDTA an inert marker of intestinal contents. Animals with biliary anastomoses showed an increased retention of the synthetic bile acid 75-SeHCAT compared to the controls. Highest retention values were found in animals with anisoperistaltic loops (t1/2 = 98.6 h). Isoperistaltic loops showed uniform values independently of the length of the Roux-limb (t1/2 = 59.8 h resp. 59.3 h). Differences to the controls (t1/2 = 42.6 h) were highly significant (p less than 0.001). In the 99m-Tc-HIDA hepatic excretion into the connected small bowel was normal in all groups. But in rats with biliary anastomoses a marked stasis of the 99m-Tc-HIDA in the Roux-Y loop was apparent. Bowel transit time tested by 51-Cr-EDTA showed comparable results in all groups without significant differences. The results demonstrate an increased bile acid retention in Roux-Y biliary anastomoses. An alteration of the enterohepatic circulation due to stasis in the Roux-Y limb seems to be the underlying mechanism.

Anastomosis, Roux-en-Y↗
PubMed1990

Diaphragmatic paralysis without bulbar or limb paralysis in multiple sclerosis.

A patient is presented in whom disabling pulmonary symptoms in the absence of other significant disability complicated a long-standing course of MS. Clinical presentation and fluoroscopy confirmed the diagnosis of bilateral diaphragmatic paralysis. Magnetic resonance imaging revealed atrophy and extensive white matter changes within the cervical cord. This case is unique in that significant respiratory compromise due to cervical spinal cord involvement by MS was dissociated from bulbar dysfunction or profound limb paresis.

Adult↗
PubMed1990

Bile acid retention after Roux-en-Y biliary reconstruction demonstrated by tauro-23-(75Se)selena-25-homocholic acid. An experimental animal study.

In this study of 65 laboratory rats the influence of biliary Roux-en-Y anastomosis on the enterohepatic circulation was investigated. Three different types of Roux-en-Y limbs were studied and compared with sham-operated controls. To collect information about the influence of the length and motility of the Roux limb, 10-cm and 3-cm isoperistaltic Roux segments and 10-cm anisoperistaltic Roux limbs were investigated. 75SeHCAT, a tau-labelled synthetic bile acid, was used for assessment of enterohepatic circulation. Intestinal transit time was evaluated by measuring the decrease of whole-body counts of 51Cr-labelled ethylenediamintetraacetic acid (EDTA), an inert marker of intraluminal contents. 99mTc-labelled dimethyl-iminodiacetic acid (HIDA) was used to detect possible alterations of bile flow. 75SeHCAT results showed marked retention of bile acids in all Roux-en-Y animals compared with controls. Results of short and long Roux limbs did not differ significantly from each other (t1/2 10 cm, 59.8 h; 3 cm, 59.3 h; control, 42.6 h; p less than or equal to 0.001). The anisoperistaltic Roux limbs showed prolonged retention even when compared with isoperistaltic limbs (t1/2 98.6 h; p less than or equal to 0.001). 51Cr-EDTA results did not show significant differences between all groups. 99mTc-HIDA showed undelayed excretion in all animals but increase of radioactivity at the site of the Roux-en-Y enteroanastomosis, indicating marked stasis in the biliodigestive Roux limb. The results demonstrate the impact of biliary Roux-en-Y anastomosis on bile acid retention due to stasis in the defunctioning jejunal segment.

Anastomosis, Roux-en-Y↗
PubMed1990

Endoscopic therapy and early elective operation as a therapeutic regimen in ulcer bleeding.

In a prospective protocol we treated 63 consecutive patients admitted to our surgical department with bleeding gastroduodenal ulcers between January 1986 and December 1987. The therapeutic regimen included emergency endoscopy in all cases. Active Forrest Ia or II hemorrhage was treated endoscopically with submucosal injection. Endoscopic control of hemorrhage was achieved in all but one case. Low-risk ulcers, e.g. Forrest II without visible vessel and III or ulcers caused by antirheumatic drug medication were treated definitively by therapeutic endoscopy (31 patients). Ulcers with high risk of rebleeding even after endoscopic therapy underwent additional early elective operation. Thirty patients were treated surgically by this means. Two patients required emergency operation because of failure to control the bleeding (Ia and second rebleeding) endoscopically. The overall mortality of the surgically treated patients was 6% (2/32). The mortality of the therapeutic endoscopy was 0%. Thus, the mortality of the overall group was 3%. The major advantages of this concept were: low mortality rates, elimination of rebleeding in the follow-up period, optimal conditions for the surgical therapy resulting in low death-rates and a reduced need for transfusions.

Adult↗
PubMed1988

[Significance of pancreatic and duodenal secretions for the protection of gastrointestinal anastomoses following stomach resection--an animal experiment study].

The consequences of deviation of pancreatic juice and bile after gastric resection were studied in an experimental animal model in 66 rats. After hemigastrectomy and Billroth I resp. Billroth II anastomoses papilla vateri was transplanted into a deep jejunal limb in a B I and a B II group each. Absence of alkaline secretions of Papilla vateri was followed by a marked increase in acidity in the gastric remnant and connected intestine. Especially in the Billroth II operated stomach we found an increased ulcer risk under these circumstances. With additional histamine-stimulation frequency of ulcer was 75% in Billroth II but only 33% in Billroth I animals. When alkaline reflux was preserved the ulcer rate ranged from 15 to 40% in all groups. These results confirmed the protective property of postresectional reflux for the integrity of anastomoses after gastric resection. The increased resistance of Billroth I anastomoses in spite of deficient luminal acid buffers could be explained by the mucus-bicarbonate-barrier of the duodenal mucosa.

Anastomosis, Surgical↗
PubMed1988

[Surgical therapy in the treatment concept of ulcer disease. A critical evaluation].

Since the introduction of H2-receptor antagonists ulcer therapy has changed in favour of conservative management against surgery. In spite of this shift in therapy mortality from peptic ulcer did not decrease through the last three decades. Obviously conservative management does not influence the rate of ulcer complications but postpones them to the aged. Peptic ulcer surgery offers differentiated therapies for complications as well as for uncomplicated ulcer disease. In bleeding ulcers combination of therapeutic endoscopy and early elective surgery reduced mortality to 5%. Targets of therapy are both bleeding and ulcer disease. Obstruction is cured in the same way as uncomplicated ulcers with additional pyloro- or duodenoplasty. In cases of perforation the decision for simple suture or definitive treatment should be orientated to ulcer history. Due to their localisation uncomplicated ulcers are treated best by selective proximal vagotomy, combined resection or Billroth I resection. After surgery the monthly recurrence risk of uncomplicated ulcers is about ten times lower than throughout long-term conservative therapy. From the present point of view only surgery seems to be able to reduce persisting rates of ulcer mortality in the future.

Combined Modality Therapy↗
PubMed1988

[Diagnostic strategies of the stomach].

Gastric surgery is still a major part of routine surgical practice. Diagnostic strategies should be oriented to the surgical consequences and their value for our understanding of pathophysiological connections. Endoscopy, perhaps with biphasic radiography, is mandatory for diagnosis of tumor malignity and localisation. Analysis of secretion is indicated in cases of ulcer recurrence. Postoperative syndromes can be detected and classified by scintigraphic methods. The new procedure of endoscopic ultrasonography seems to offer special benefits for diagnostic problems such as gastric lymphoma and other intramural tumors.

Diagnosis, Differential↗
PubMed1988

[The surgical treatment concept in acute intestinal hemorrhage].

A clinically developed and prospectively verified therapeutic concept for acute intestinal bleeding is presented in this paper. Emphasis is laid on orthograde lavage likely to enable sooner and more effective use of diagnostic means and to provide optimal conditions for surgical therapy. Prognosis can be further improved by differentiated use of therapeutic endoscopy and early elective surgery. The effectiveness of this new therapeutic concept has been successfully verified on 81 patients, between 1975 and 1986. Lethality amounted to five per cent.

Colectomy↗
PubMed1987

[Recurrent gastroduodenal ulcer: controversies in primary and secondary interventions].

Today controversial points of view in ulcer surgery are related to operative tactics. In principal resective and non-resective procedures and the type of anastomosis are discussed. Physiopathological criteria for decision are the effects on acid reduction, motility, intestinal acid exposure and entero-gastric reflux. Therapeutic security and the frequency of side effects are determined by these parameters. Postpyloric ulcer remains the domain of vagotomy. Gastric ulcers should be resected or treated by a combined procedure. In reconstructing the gastrointestinal tract the dualism of residual acid and postresectional reflux must be taken into account.

Anastomosis, Surgical↗
PubMed1987

[Diagnosis and therapy of late intestinal radiation sequelae].

Diagnosis and therapy of the complications of intestinal radiation is characterized by uncertainty due to the lack of data. We report our experience of 285 patients who have been followed through the years 1967-1984 which might serve as a basis for diagnosis and therapy. In emergency situations diagnosis includes ileus, perforation and massive bleeding. Operative therapy should be performed stepwise and with caution. During free intervals complete diagnosis of all possible complications including a restaging of the underlying disease should be performed. Resection of the affected intestine is the surgical method of choice. The rate of severe complications was lowered substantially; mortality was 4% (7/159).

Abdominal Neoplasms↗
PubMed1986

[Indications and choice of surgical procedure in bleeding gastroduodenal ulcer].

Lethality of bleeding peptic ulcer has been reduced to about 15 per cent in recent years by therapeutic endoscopy in combination with differentiated surgical tactics. Intensity and activity of bleeding as well as additional criteria, such as localisation, recurrence of bleeding, and age of the patient, are some of the parameters for surgical indication which are used in decision-making, with due consideration of the spontaneous course. Endoscopic haemostasis should be intensively used to avoid emergency operations and action of early recurrence. Selective early surgery should be performed whenever possible. Surgical techniques should be chosen with two objectives in mind, localised haemostasis and definitive ulcer treatment. Extraluminal and intraluminal ligation and additional vagotomy should be the optional approach to bleeding peptic ulcer. Billroth's I operation should be applied to ventricular ulcer.

Arteries↗