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Biomedical subjects

H Groitl

Publications and source records attributed to H Groitl.

At least 19 recordsLinked to original sources
PubMed1999

Percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) for decompression in the upper gastrointestinal tract. Initial experience with palliative treatment of gastrointestinal obstruction in terminally ill patients with advanced carcinomas.

BACKGROUND: Signs of gastrointestinal obstruction, with intractable vomiting and an inability to take oral food, are common symptoms in terminally ill cancer patients with advanced primary tumors or peritoneal carcinomatosis. The application of percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEJ) instead of the usual nasoenteral tube is a simple method of achieving permanent decompression in the upper gastrointestinal tract. The goals of this study, in addition to establishing indications and outcome, were to identify specific aspects of tube placement and to determine the incidence of complications. METHOD: Over a period of 3 years, a total of 24 consecutive patients (mean age, 64 years; range, 37-83 years) underwent either a PEG (17/71%) or a PEJ (seven/29%). RESULTS: In all patients, PEG/PEJ obviated the need for the nasoenteral tube. A total of 22 patients (92%) were enabled to take liquids orally, and 20 (83%) were discharged to home care. With the exception of a single spontaneous dislodgement of the PEG tube, no major complications were observed. CONCLUSION: We believe that PEG/PEJ represents an effective, minimally invasive, and cost-effective method for gastrointestinal decompression in patients with advanced incurable cancer.

Abdominal Neoplasms↗
PubMed1997

Risk of invasive carcinoma in colorectal adenomas assessed by size and site.

BACKGROUND: The risk of invasive carcinoma developing in colorectal adenomas is influenced by a number of characteristics of both patients and adenomas, and the composition of the sample analysed. PATIENTS AND METHODS: Between 1978 and 1993 more than 20,000 polyps were prospectively documented at the Erlangen Registry of Colorectal Polyps, and analysed statistically by logistic regression. RESULTS: The size of the adenomas proved to be the most important factor for adenomas equal to or larger than 15 mm as compared with smaller lesions. In 5,137 diminutive adenomas (< or = 5 mm) invasive carcinoma was never found. Adenomas in the right-sided colon had a lower risk than those in the left colon or rectum, but with increasing adenoma size, the malignancy rate showed a right-sided shift. In adenomas of up to 36 mm in diameter, invasive carcinoma was found more often when they were located in the rectum or left colon while adenomas larger than 36 mm were more likely to harbour invasive carcinoma when located in the right or left colon rather than in the rectum. CONCLUSIONS: A multivariate analysis of 11,380 adenomas detected at the first total colonoscopy showed that the factors size and site, both of which can be assessed by endoscopic inspection alone, were found to enable a statistically and clinically adequate assessment of the malignancy risk.

Adenoma↗
PubMed1997

Invasive carcinoma in colorectal adenomas: multivariate analysis of patient and adenoma characteristics.

BACKGROUND AND STUDY AIMS: The risk of invasive carcinoma developing in colorectal adenomas is influenced by a number of characteristics, relating both to the patients and to the adenomas, and by the composition of the sample analyzed. The aim of the present study was use a multivariate analysis to investigate the risk of invasive carcinoma in endoscopically and surgically removed adenomas. PATIENTS AND METHODS: Between 1978 and 1993, more than 20,000 polyps were prospectively documented at the Erlangen Registry of Colorectal Polyps. A multivariate analysis of 11,188 adenomas detected at the first total colonoscopy was carried out in order to investigate the risks associated with size and site--both of which can be assessed by endoscopic inspection alone- and the extent to which these may be modified by other patient and adenoma characteristics, with an influence on the risk of invasive carcinoma in colorectal adenomas. RESULTS: The size of the adenoma proved to be the most important influencing factor. Invasive carcinoma was never found in 5027 small adenomas (< or = 5 mm). Adenomas in the right colon had a lower risk than those in the left colon or rectum. But with increasing adenoma size, the malignancy rate showed a right-sided shift, with a significant interactive effect of size and right-sided location. However, the risk determined by the size and site of the adenoma was significantly modified by a number of patient and adenoma characteristics, including histological type, presence of multiple adenomas, and patient age and sex. CONCLUSIONS: The risk of invasive carcinoma in colorectal adenomas can only be adequately described by a complex model of the interactive effects of patient and adenoma characteristics on the main factors of size and site.

Adenoma↗
PubMed1996

[Endoscopic treatment of anastomosis insufficiency and perforation in the esophagus with fibrin glue].

The incidence of anastomotic dehiscence following oesophageal or gastric resection reported in European studies varies between 3.5 and 25%. The outcome of these patients is usually not explained nor is there a relevant number of studies concerning the treatment of this situation. Oesophageal perforation is rare but is commonly combined with high morbidity and mortality. Operative treatment mostly means major surgical procedures. In our institution endoscopic treatment of these defects has been established since 1985. Following the endoscopic diagnosis, the extent of the defect becomes radiologically documented by filling the cavity with contrast media. This also shows any contact to intraoperatively placed drainages. The lesions and abscess cavities are then endoscopically flushed with saline solution on a daily basis analogously to an internal drainage until surfaces are cleansed. Developing granulation tissue and cleansed surfaces are then covered with fibrin tissue adhesive to support shrinking of the defect. During the last 9 years, we treated 46 cases of anastomotic dehiscence and 9 oesophageal perforations applying this regimen. About 50% of the patients showed signs of sepsis at the beginning of their course. The defects were between 1 and 400 ml in size. In a median number of 4 (1-19) endoscopies a median of 8 (1-81) ml of fibrin tissue adhesive was applied. The average costs for fibrin tissue adhesive were about US $720. Close to 80% of the lesions could be healed, only 14% of the patients developed oesophageal stenosis with a consecutive need of dilatation. We therefore conclude that this method is helpful in treating patients with oesophageal lesions, especially if they are in reduced general condition and are at high risk for operative interventions.

Esophageal Neoplasms↗
PubMed1991

[Laparoscopic cholecystectomy: experiences in Erlangen].

From February 2, 1990 to June 15, 1991, a total of 160 patients were subjected to laparoscopic cholecystectomy. The procedure was successful in 150 patients, while in ten patients the procedure was converted to conventional cholecystectomy for the following reasons: suspected malignancy (2), cystic duct stone (1), dysfunction of equipment (2), adhesions (1), concomitant liver tumor (1), abscess in the hepatoduodenal ligament following endoscopic papillotomy (1), and chronic cholecystitis (2). Four patients developed substantial complications. Two patients developed biliary leakage requiring laparotomy and endoscopy placement of a nasobiliary tube in one case each. The other two patients developed intraabdominal bleeding that forced an emergency laparotomy in one case. With increasing experience in laparoscopic cholecystectomy, we would only consider a preoperative suspicion of malignancy as an absolute contraindication.

Adolescent↗
PubMed1987

Initial experience with the endoscopic application of fibrin tissue adhesive in the upper gastrointestinal tract.

During a 15-month period, a total of 11 patients underwent endoscopic application of fibrin tissue adhesive in the upper gastrointestinal tract. Our sample consisted of 6 patients with control of bleeding, 4 patients with management of anastomotic leaks, and one very old man undergoing prophylactic sealing of a chronic gastric ulcer with a visible vessel and repeated episodes of bleeding. The method described has proven to be successful in control of bleeding in every case and has resulted in quick cleaning of perianastomotic abscess cavities, growth of granulation tissue, and complete healing in 3 of 4 cases so far. This preliminary report suggests that fibrin adhesive application is effective in the control of oozing gastrointestinal bleeding and may support the healing process in difficult situations, such as chronic peptic ulcers and anastomotic leakages.

Adult↗
PubMed1986

Tumor stenoses of the upper gastrointestinal tract--therapeutic alternatives to laser therapy.

Alternatives to laser treatment of tumor stenoses of upper gastrointestinal tract include dilatation, implantation of bridging tubes, radiation therapy and chemotherapy. Based on the experience of 170 bridging tubes implanted and laser therapy in 70 patients with tumor stenoses (presented elsewhere) "tubes and laser" are compared. Complication rate, applicability in very proximal and distal stenoses are in favour of laser therapy, costs, hospitalisation time, possibility to occlude fistulae and short recurrence time after laser therapy are facts speaking for oesophageal bridging tubes. The question "tubes or laser" has to be answered by "tubes and laser" already.

Cisplatin↗
PubMed1985

[In-vitro induced histamine liberation from mucous membrane of the stomach and duodenum before and following vagotomy].

In 13 patients suffering from duodenal ulcer and undergoing vagotomy biopsies were taken from mucosa of the gastric fundus and of the duodenum. Histamine release from the samples upon challenge to different food was assayed before and after vagotomy. Generally, more histamine was set free from gastric mucosa than from the duodenal one. However, in 11 of 13 subjects there was an alternative shift in the fundus and in the duodenum after vagotomy.

Adult↗
PubMed1985

[Effect of anastomosis technic on wound healing in the gastrointestinal tract. Animal experiment study of the dog colon with special reference to manual suture technics].

Three manual suture techniques (double-layer inverting, single-layer end-to-end, and continuous suture of the submucosa) were compared with anastomoses performed by stapling instruments (EEA, KZ 28) on the canine colon. The two manual techniques with exact end-to-end apposition led to primary wound-healing during the early postoperative period (3-20 days). There was no significant stenosis at the site of anastomosis five and ten months postoperatively. Inverting sutures as well as stapled anastomoses, however, showed delayed healing with considerable inflammatory reaction, resulting in marked stenosis after five to ten months.

Animals↗
PubMed1984

[Palliative endoscopic therapy of esophageal carcinoma].

Endoscopic insertion of esophageal bridging tubes provides palliative therapy in patients with inoperable esophageal carcinoma. Indications are tumor stenoses and esophago-bronchial fistulae. In 138 patients endoscopical application of bridging tubes was performed: 51 esophageal, 42 cardiac and 24 gastric carcinoma, six tumor stenoses caused by bronchial carcinoma and 15 esophago-bronchial fistulae. Letality rate was 8,5%, which is significantly less compared to operative methods. Average survival time of 120 days after implantation seems not to be prolonged despite marked improvement of symptoms, especially of dysphagia.

Aged↗
PubMed1984

Endoscopic treatment of scar stenosis in the upper GI tract.

Short cicatricial stenoses following surgery of the upper gastrointestinal tract are difficult to treat and have a high recurrence rate. A method of eliminating stenoses endoscopically with the aid of diathermy is described. This method has, to date, been employed in 51 patients, and only a single serious complication has been observed. The procedure can thus be recommended, since reoperation with resection of the anastomosis is associated with a very high rate of complications. A new method of treating scar stenosis in the upper GI tract, which develops in particular after surgical anastomosis of the esophagus, is described, in 51 patients this method helped replace bougienage. This method obviates the need for life-long, unpleasant dilatation with the bougie in the mostly elderly patients.

Adult↗