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Biomedical subjects

H Messmann

Publications and source records attributed to H Messmann.

At least 19 recordsLinked to original sources
PubMed2006

[Barrett's esophagus carcinoma].

The incidence of Barrett's esophagus, long segment as well as short segment, has increased over the last few years. One major reason for this was the increasing number of endoscopies. However there is a simultaneous increase of Barrett's adenocarcinoma in the Western world, while the number of squamous epithelium cancer decreases. Besides improved endoscopic diagnosis other exogenous factors such as nutrition, reflux or adipositas play an important role. Due to available data it is clear that the risk of Barrett's esophagus has been overestimated, mainly because of a publication bias. The risk of a Barrett's esophagus carcinoma has been published with 0.5%/year. The U.S. and German guidelines do not recommend screening endoscopies for the general population, however for those with a long-lasting reflux disease for several years. The diagnosis of Barrett's esophagus is made endoscopically and histologically, this means 4 quadrant biopsies every 1-2 cm are gold standard. Staining with methylene blue or acetic acid in combination with zoom endoscopy may improve the diagnosis. In patients with proven Barrett's esophagus regular surveillance endoscopies depending on the presence of intraepithelial neoplasia are recommended. While patients with Barrett's esophagus and no or with low grade intraepithelial neoplasia need only surveillance, those with high grade intraepithelial neoplasia should be treated. EMR is a promising treatment of visible lesions, which is similar effective as surgery but with a lower morbidity and mortality. Non visible lesions can be treated promisingly by PDT. Similar to high grade intraepithelial neoplasia mucosal cancer can also be treated endoscopically. However, submucosal cancer needs surgery.

Adenocarcinoma↗
PubMed2006

[Aortoduodenal fistula as a cause of gastrointestinal bleeding--difficulties in endoscopic diagnosis].

We report on three patients with severe gastrointestinal bleeding arising from aortoenteric fistula. Two patients presented with a secondary aortoduodenal fistula. In the first case bleeding occurred 8 months after aortobifemoral graft implantation. In the second patient aortobiliacal graft implantation was performed 22 years before. In the third case the aortoenteric fistula was primary and was caused by an abdominal aortic aneurysm without prior vascular intervention. In the first case diagnosis was made by urgent endoscopy visualizing ongoing bleeding from the duodenal fistula. In the two other patients urgent endoscopy and CT as well could not demonstrate the bleeding source. Aortoenteric fistula was diagnosed endoscopically during severe rebleeding some hours later. Two patients underwent surgery with implantation of an axillobifemoral bypass; the third patient declined further intervention and died. The course shows that aortoduodenal fistula can present with severe but intermittent gastrointestinal bleeding making the diagnosis in the non-bleeding interval difficult. In patients with severe gastrointestinal bleeding and a history of aortic disease (aneurysm, prior aortic graft repair or stenting) an aortoduodenal fistula should be suspected and the indication for surgical intervention should be considered early in spite of negative results of endoscopy and CT.

Aged↗
PubMed2005

[Abdominal ultrasound after endoscopic or percutaneous stenting and drainage].

Stents and prostheses in the hepatobiliary system are visible by ultrasound examination and can be checked for their function. The reappearance of mechanical cholestasis, stent dislocation or formation of sludge on the stent tip is signs of stent dysfunction. Graduation of the biliary obstruction can help to find the best time for changing the stent. After intervention hematoma, abscess, intraabdominal fluid or gas may occur and can be diagnosed by ultrasound. Tumor stenosis in the gastrointestinal tract can be treated by self expandable metallic stents. Ultrasound helps to localize the stent in the correct position and to observe the reduction of occlusive ileus. Percutaneous and gastrointestinal drainage of pancreatic cysts, necrosis and abscesses are often controlled by ultrasound to evaluate size, echogenicity and localized pain. Many procedures and interventions in gastroenterology can be monitored by an experienced ultrasound examiner in an effective and inexpensive manner.

Abdomen↗
PubMed2005

Barrett's esophagus: a discrepancy between macroscopic and histological diagnosis.

BACKGROUND AND STUDY AIMS: The diagnosis of Barrett's esophagus at present requires endoscopic and histological confirmation of specialized intestinal metaplasia. This study prospectively analyzed the endoscopic and histological prevalence of Barrett's esophagus and the risk factors for the presence of Barrett's esophagus among patients being treated in an endoscopy unit. PATIENTS AND METHODS: A total of 474 unselected patients (58% men; mean age 52 y) were included in the study. Two biopsy specimens each were taken from below and above the squamocolumnar junction and from the antrum and gastric body. Four-quadrant biopsies were taken every 1-2 cm to confirm a macroscopic suspicion of Barrett's esophagus. RESULTS: Barrett's esophagus was suspected at endoscopy in 109 patients (23%). Of the 109 patients with endoscopically suspected Barrett's esophagus, only 46 (42%) had the finding confirmed histologically. The sensitivity and specificity for the endoscopic diagnosis of Barrett's esophagus were 62% and 84%, respectively. A multivariate logistic regression analysis identified age (P = 0.0001; odds ratio per life-year 1.087; 95% CI, 1.046-1.139), male sex (P = 0.0020; OR 6.346; 95% CI, 2.094-22.314), and the number of biopsies (P = 0.0025; OR 1.661; 95% CI, 1.247-2.392) as factors associated with evidence of intestinal metaplasia on biopsy. CONCLUSION: The striking discrepancy between the endoscopic findings and the histological diagnosis may be due to the focal distribution of intestinal metaplasia. This emphasizes the importance of an adequate biopsy protocol. In addition, better methods of detecting focal islands of intestinal metaplasia that are not visible at conventional endoscopy are needed.

Adolescent↗
PubMed2005

Whipple's disease presenting as an isolated lesion of the cervical spinal cord.

Chronic myelitis from Whipple's disease of the spinal cord is extremely rare. The differential diagnosis includes chronic inflammatory lesions, viral or bacterial infections, and tumours of the spinal cord. Here we present a 50-year-old man with mild sensory deficits because of a large lesion of the cervical spinal cord who markedly showed improvement during probatory antibiotic therapy. PCR and jejunal biopsy were initially negative and only later confirmed the diagnosis of Whipple's disease. Clinical and neuroradiological criteria are suggested which may be of help in the early diagnosis of spinal Whipple's disease before confirmation by molecular biology or histology.

Anti-Bacterial Agents↗
PubMed2004

Endoscopic and surgical management of leakage and mediastinitis after esophageal surgery.

Due to the specialisation of esophageal surgery a significant reduction of post-surgical mortality was possible during the last few decades. Nevertheless a high complication rate of about 30% remains even in the hands of experienced surgeons. Anastomotic leakage has an incidence between 5 and 30% leading to serious postoperative morbidity. With a broad range of conservative and endoscopic therapeutic methods there is encouraging progress in shortening the time to closure of the leakage and reducing the risk of severe systemic complications such as sepsis or malnutrition. If conservative therapy fails, re-surgery remains as an ultima-ratio option.

Anastomosis, Surgical↗
PubMed2003

A multimodal treatment approach including high-dose chemotherapy in very advanced gastric cancer: evidence for control of metastatic disease.

The present multimodal treatment approach was designed to achieve prolonged tumor control in advanced gastric cancer. A total of 26 patients with stage IV gastric cancer (metastatic disease n=25), ECOG performance status 0-3 and laparoscopically evaluated peritoneal status received a modified EAP schedule to prove chemosensitivity and to mobilize autologous peripheral blood stem cells (aPBSC). Patients without progressive disease proceeded to tandem high-dose chemotherapy (HD-CT) and aPBSCT. Patients with >50% reduction of the target lesion received a second cycle of HD-CT. Responders were selected for local R0 resections (D2 resection) according clinical criteria. Of 26 patients, 20(77%) achieved partial remission after dose-intensive chemotherapy: local R0 resection was achieved in 12 out of 14 patients selected for surgery (46% of all patients). Eight of these R0-resected patients initially had peritoneal carcinomatosis. With a median follow-up of 3.2 years, four patients are still alive. The median overall survival was 8.4 months (CI 2.5-14.4 months), for histologic regression grade 3 (seven out of 25 patients, 28%) 29 months (CI 12-46 months). The combined treatment approach is tolerable and feasible in advanced disease and opens a therapeutic window for a significant proportion of patients, even in cases with histologically proven peritoneal carcinomatosis.

Adult↗