[Secondary debulking operation in ovarian cancer].
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Chemotherapy, Adjuvant↗
Biomedical subjects
G Schattenmann
Publications and source records attributed to G Schattenmann.
[Developments in the therapy of advanced FIGO III ovarian cancer].
From 1982 to 1992 103 patients with ovarian cancer stage FIGO III have been treated. In 38% of the patients there was no residual tumour postoperatively, in 40.8% the residual tumour was smaller than 2 cm. In 51.5% bowel resections were necessary, a stoma was unavoidable in just one case. A lymphadenectomy (pelvic, paraaortic or combined) was done in 46.6% of the patients. Postoperatively, 54.4% of the patients received a platinum-based chemotherapy, in the other patients other kinds of chemotherapy were applied. A radiation of the whole abdomen was done only in 3.9%. A median survival time for more than 60 months could be achieved in tumour-free patients due to the increased radical operations in combination with the platinum based chemotherapy. The lymphadenectomy seems to prolong the survival time of the patients. The positive nodal status is definitely unfavourable for the prognosis. By this therapeutic approach, an increased survival time with a good life quality can be achieved.
Adult↗
Different response of gastric inhibitory polypeptide to glucose and fat from duodenum and jejunum.
Gastric inhibitory polypeptide (GIP), insulin, and blood glucose after ingestion of glucose or fat were examined in patients after gastrectomy with esophagojejunostomy or esophagoduodenostomy. After a glucose load patients without duodenal passage had significantly higher glucose and significantly smaller insulin levels than patients with duodenal passage. The fasting levels of serum immunoreactive GIP were moderately elevated and reached significantly higher levels after oral glucose ingestion in both gastrectomized groups as compared with normal subjects. In patients with preserved duodenal passage serum IR-GIP levels peaked earlier and were significantly higher than in patients without duodenal passage. In contrast to the finding after oral glucose ingestion, the IR-GIP response to an oral fat load was nearly twofold greater in patients without duodenal passage than in patients with duodenal continence. Thus, glucose-induced GIP release is mainly of duodenal and fat-induced GIP release mainly of jejunal origin. This suggests the existence of two types of GIP cells.
Adult↗
Effect of a transpyloric tube on gastric emptying and duodenogastric reflux in the dog.
The effect of a transpyloric tube on duodenogastric reflux and on gastric emptying was studied in dogs with either an intact pylorus, a Heineke-Mikulicz pyloroplasty, or an extramucosal circular pylorectomy. In fasting dogs, duodenogastric reflux was 10 times smaller than after feeding a liquid lipid meal. A transpyloric tube increased the reflux rate in fasting, but not in fed dogs, while pylorectomy increased reflux rate and intragastric accumulation of a duodenal marker in fed, but not in fasting dogs. It is concluded, therefore, that in the dog (1) methods to measure duodenogastric reflux should not involve the necessity to position a transpyloric tube and (2) the pylorus and adjacent structures are involved in keeping duodenogastric reflux at a low level.
Animals↗
Gastric emptying and postprandial duodenogastric reflux in dogs with Heineke-Mikulicz pyloroplasty.
A two-marker technique avoiding transpyloric intubation was used to measure the volume of gastric secretion, the rate of gastric emptying and the degree of postprandial duodenogastric reflux in 8 dogs, 5 without and 3 with Heineke-Mikulicz pyloroplasties. The stomach emptied after a liquid fatty meal at an overall rate of 4.9 ml/min +/- 0.2 s.e.m. in animals with a normal pylorus and 5.7 +/- 0.2 ml/min in those with pyloroplasties (P less than 0.05). Though mean fractional emptying rates were similar, the fractional emptying rate was greater in animals with pyloroplasties than in those without in the first 10 and in the last 20 minutes. The rate of duodenogastric reflux was likewise greater in animals with pyloroplasties than in those without (1.8 +/- 0.2 ml/min and 0.7 +/- 0.2 ml/min respectively, P less than 0.05). The rates of gastric secretion did not differ materially (2.2 +/- 0.3 ml/min and 2.1 +/- 0.2 ml/min), but a greater proportion of the gastric contents was emptied more than once in animals with pyloroplasties than in those without (7.7 +/- 1.5 per cent and 2.3 +/- 1.0 per cent, P less than 0.05).
Animals↗
Gastric emptying and postprandial duodenogastric reflux in pylorectomized dogs.
A two-marker technique was used to determine gastric emptying rate and postprandial duodenogastric reflux rate without transpyloric intubation. The fractional gastric emptying rate in five dogs with normal pylorus was 3.0 +/- 0.3 (SE) X 10(-2)/min. In three dogs with circular pylorectomy, it was 5.8 +/- 0.8 X 10(-2)/min (P less than 0.01). The duodenogastric reflux rates were 0.72 +/- 0.23 (SE) ml/min and 3.21 +/- 0.97 ml/min. (P less than 0.05). The percentage of the test meal that by to-and-fro movements across the pylorus was emptied more than once was 2.3 +/- 1.0 (SE) in normal dogs and 15.5 +/- 2.4 after pylorectomy (P less than 0.005). Because the higher emptying rate was accompanied by more to-and-fro movements, the amount of the meal remaining in the stomach, and thus net gastric emptying, was similar in both groups. It is concluded that pylorectomy increases both reflux rate and emptying rate. This effect on emptying can only be detected by a method that includes the measurement of to-and-fro movements across the pylorus. The pylorus thus appears to prevent postprandial duodenogastric reflux and to slow gastric emptying.
Animals↗
Duodenogastric reflux in the dog.
Duodenogastric reflux, gastric emptying, and gastric secretion were measured simultaneously by a double-marker technique after instillation of a liquid lipid meal (300 ml Intralipid) or a protein meal (300 ml Bactopeptone) in five trained mongrel dogs. A lipid meal was emptied slower and elicited less volume secretion than a protein meal. Duodenogastric reflux rate and intragastric accumulation of duodenal contents were similar with both meals. Intravenous infusion of atropine slowed gastric emptying and inhibited gastric volume secretion only in the case of protein meal. Atropine increased duodenogastric reflux rate and gastric accumulation of duodenal contents with both protein and lipid meals. The percentage of duodenal contents inside the stomach increased continuously during gastric emptying; it did not exceed 20% with both meals given alone and 40% with both meals given together with atropine. It is concluded that duodenogastric reflux and gastric accumulation of duodenal contents are common phenomena during gastric digestion of a meal. The degree of such accumulation does not depend on the type of meal. Intragastric accumulation of duodenal contents is increased when duodenogastric reflux rate is stimulated and when gastric emptying rate is inhibited simultaneously.
Animals↗
Duodenogastric reflux in the fasting dog: role of pylorus and duodenal motility.
A two-marker technique was used to determine duodenogastric reflux in fasting dogs with normal or surgically modified gastroduodenal junctions. All nine dogs had an esophagostomy for gastric marker perfusion. The duodenal marker was given via a duodenal fistula. In two dogs a Heineke-Mikulicz pyloroplasty was performed, and in four dogs extramucosal circular pylorectomy was performed in addition. The mean fasting duodenogastric reflux rate in dogs with a normal pylorus was 1.1 +/- 0.5 (SE) ml/10 min; after pyloroplasty it was 1.6 +/- 0.3 ml/10 min (P greater than 0.1), and after pylorectomy it was 1.5 +/- 0.4 ml/10 min (P greater than 0.1). Simultaneous intraduodenal manometry revealed no relation between the interdigestive myoelectric complex and reflux. The marker technique for the measurement of reflux was validated by pharmacologically induced reflux. Subcutaneous injection of 0.1 mg of apomorphine increased the reflux rate tenfold. A transpyloric tube increased reflux rate fivefold. It is concluded that, in the fasting dog, phenomena such as retropulsive peristalsis are determinants of duodenogastric reflux and not the presence or absence of the pylorus and normal interdigestive motility.
Animals↗
A quantitative assessment of duodenogastric reflux in the dog after meals and under pharmacological stimulation.
Duodenogastric reflux was measured in the dog by a double marker technique which does not interfere with the gastroduodenal junction. Duodenogastric reflux occurred both with a lipid and a protein meal. The gastric accumulation of duodenal contents was higher with fat than with protein because fat slowed gastric emptying. It was even higher with atropine because in addition to slowing gastric emptying atropine also increased the reflux rate. The effect of atropine was offset by a histamine H1 agonist.
Animals↗
[Cardial function after a proximal gastric vagotomy].
We realize this study with the purpose of verifying if the cardias is affected or not by the proximal gastric vagotomy. Thirty six (36) patients suffering from chronic recurrent duodenal ulcer without complications were examined in sucession immediately before the operation and also three and twelve months after operation. The PGV was carried out without drainage. Only two cases needed pyloroplasty (Finney Type) due to stenosis of the pylorus. The completeness of the vagotomy was comprobated through the insulin test which was made three months postoperatively. This was obtained in 89% of the cases. We took 12 volunteers that they were not suffering from known disease of esophagus or stomach. The tests made to observe the function of the cardias after the proximal gastric vagotomy (PGV) were: Manometry, pH metry and Endoscopy/Histology. The obtained results are established. The conclusions of this work are drawn.
Cardia↗
[Therapeutic results of peptic stenosis in the esophagus (author's transl)].
Of 118 patients treated for peptic stenosis between 1970 and 1979, 89 cases (75.4%) had developed in connection with endobrachyesophagus, i. e., as the result of primary reflux disease; 26 cases were the consequence of secondary reflux disease without endobrachyesophagus. In three cases the peptic stenosis had to be explained as the result of a local acid secretion. The treatment which followed was conservative (bougienage + Cimetidine/Antacids) or operative (bougienage + fundoplication). The results of the therapy varied according to the type of stenosis. In cases where the stenosis was located in the upper part (endobrachyesophagus), good results could be achieved with conservative therapy in 38.3% and with operative therapy, in 67.3%. The results were worse in terminal stenosis (conservative therapy, 45.5%; operative therapy, 60%). Retrospective analysis of unsuccessful treatment shows that predominantly scarred stenosis shows worse results than florid stenosis with recent esophagitis.
Adult↗
[Komarov-oesophagostomy and duodenocutaneous jejunal segment: a simple model for examination of the gastroduodenal region in the dog (author's transl)].
Direct and partially indirect methods to quantify gastro-duodenal motility in the dog require direct access to the stomach or duodenum without disturbance of the structures to be assessed. A procedure is presented, which combines Komarov-oesophagostomy and the process of duodenocutaneous jejunal segment. This procedure has proven to be simple and secure in technique and without problem in chronic experimentation.
Animals↗
[Endoscopic-pneumatic dilation (EPD) for the treatment of achalasia (author's transl)].
The endoscopic pneumatic dilation (EPD) procedure introduces an instrument which can be used in combination with fiberoptic-endoscopes types GIF-P and GIF-P2. The dilator is characterized by simple, easy, and gentle handling, even with extreme deviation at the gastro-esophageal junction. In daily clinical routine it has been shown to be effective in the treatment of achalasia.
Dilatation↗
[Cardia function after proximal-gastric vagotomy (author's transl)].
In 36 patients with chronic duodenal ulcer disease LES-function before and after proximal-gastric vagotomy was examined manometrically and by determining pH-values in a prospective study. In addition, esophagus biopsies were taken 5 cm proximal of the cardia. 12 healthy volunteers served as controls. A direct effect of proximal-gastric vagotomy on LES-function could not be shown. On the contrary, in 38,9% of the patients examined, preoperatively proven esophagitis disappears nearly completely 12 months following proximal gastric vagotomy. This positive effect of vagotomy is to be interpreted as a beneficial effect on regurgitated intestinal juice, more so than an effect on cardia function itself.
Adult↗
[Vagotomy and lower esophageal sphincter (LES) (author's transl)].
Selective proximal vagotomy does not influence the function of the cardia. Only high intrathoracic vagotomy results in a decrease of LES pressure. Esophagitis, which is found in a high percentage of preoperative duodenal ulcer patients, heals after SPV.
Animals↗
[The Göttingen pH measurement technic. Telemetric, long-term pH measurement of the esophagus].
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Esophagus↗
[Clinical significance of hiatal hernia].
A careful clinical investigation of 245 patients with hiatus hernia was performed. (History and physical examination, x-ray tests, oesophago-gastroscopy with biopsies, 3-point-manometry, rapid pull-through manometry with pentagastrintest). Classification of hiatus hernia was performed by x-ray test. (222 axial hiatus hernia, 14 mixed hiatus hernia, 9 paraoesophageal hiatus hernia) 3-point-manometry and rapid pull-through manometry with Pg-test were used to differentiate the function of the cardia. In spite of a strong selection in 84 out of 245 patients examined in our hospital, a sufficient cardia could be seen. 161 cases showed a gastro-oesophageal reflux which has been in accordance with a decompensated reflux disease in 97 patients. Solely in these 97 patients an operative correction of the gastro-oesophageal reflux seemed convenient. 84 patients showed a considerable variability of oesophageal disorders. In a final correlation between endoscopy, manometry and x-ray tests our opinion was confirmed that hiatus hernia must not lead inevitably to an insufficiency of the cardia. In the above investigations it could be shown that any therapeutic proceeding in the treatment of hiatus hernia first needs a careful analysis of the cardiac and oesophageal activity and second requires a careful indication for the surgical treatment of hiatus hernia.
Cardia↗
[Cardia function following Billroth I and Billroth II gastrectomy (studies on the significance of duodenal passage for cardia function)].
To clarify whether the duodenum is important to the regulation of cardia function, patients with B-I and B-II resections were investigated manometrically. A test meal can stimulate the LES in patients with a B-I resection almost to the same extent as that in healthy test persons. Symptom-free patients with the distal stomach resection and gastrojejunostomy (B-II) do not show this pressure reaction. Therefore, the duodenal passage could be of importance to cardia function. In patients with a transformation operation of B-II in B-I, because of postgastrectomy symptoms a stimulation of the LES cannot be achieved either before or after the transformation operation. We cannot presently clarify the type of the cardia regulation since the IRG levels measured do not explain this phenomenon.
Adult↗