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Biomedical subjects

J F Erckenbrecht

Publications and source records attributed to J F Erckenbrecht.

At least 19 recordsLinked to original sources
PubMed2001

[Preoperative risk assessment and perioperative management of HIV-infected patients].

PROBLEM: Due to their impaired immune function, unusual multimorbidity, and extensive concomitant medication HIV-infected patients impose special and specific demands on those who deal with their perioperative care. PREOPERATIVE ASSESSMENT: Beside standardized diagnostic and therapeutic preparations the preoperative knowledge, quantification, and treatment of HIV-associated opportunistic disorders and chronic organ damage are of particular importance. This requires an extended problem-orientated work-up. Furthermore, antiretroviral medication may interact with perioperatively administered pharmaceutics and lead to hardly foreseeable synergistic and antagonistic adverse effects. In contrast, "drug holidays" favor the development of HIV drug resistance. OPERATIVE MANAGEMENT: Anesthetic and surgical procedures basically depend on the underlying indication and consequently follow common principles. Laparoscopic techniques do not have any specific advantage in HIV-infected subjects. PERIOPERATIVE MORBIDITY: During their postoperative course, HIV-infected patients have to be more often admitted to intensive care unit and kept on artificial respiration unplannedly. Perioperative morbidity of HIV-infected patients increases with the stage of their disease. It is, however, not significantly elevated compared to that of HIV-negative subjects in similar preoperative health condition.

Anti-HIV Agents↗
PubMed2001

[Spectrum and results of operative interventions in HIV infection patients].

Owing to their number, multimorbidity, and prolonged survival following improved antiretroviral therapy, HIV-infected subjects represent an important subgroup of the patients requiring surgical treatment. The spectrum of operative interventions performed in these people comprises both characteristic diagnostic, palliative, and therapeutic measures and all the same surgical indications as in an age-matched non-HIV-infected patient population. Published data concerning the results of operative interventions in these patients are rather scarce. The surgical success rate is 68-90% for elective therapeutic measures. In 21-94% of HIV-infected patients intraoperative findings of a HIV-associated opportunistic disease are reported. Depending on patient selection and the kind of operation performed, the perioperative morbidity of these subjects was 9-87% (median 33.5%), while postoperative mortality ranged from 0 to 71% (median 8%). Particular determining factors of perioperative morbidity and mortality are the degree of individual immunosuppression and the urgency of surgical intervention. In summary, operation-associated morbidity and mortality of HIV-infected patients appear not to be significantly increased compared to non-HIV-infected patients in similar preoperative health condition. The present analysis reflects a marked improvement of operative results in HIV-infected patients during the past 20 years.

AIDS-Related Opportunistic Infections↗
PubMed2001

Effect of balloon compliance on symptomatic success of pneumatic dilation in achalasia patients.

BACKGROUND: Pneumatic dilation is the standard non-surgical treatment of achalasia. The dilation devices in use differ in their physical properties, particularly with regard to balloon compliance. PATIENTS AND METHODS: 35 achalasia patients (18male, 20-82 years, median 45 years) diagnosed by accepted criteria were prospectively and randomly assigned to 39 dilation procedures by either a low compliance dilation device (LCDD, polyethylene balloon, Rigiflex(trade mark), Microvasive Boston Scientific, USA, n = 18) or a high compliance dilation device (HCDD, latex balloon, Rüsch Inc., Germany, n = 17). Individual complaints were graded by a standardized questionnaire before treatment and prospectively after a median of 3 and 13 months. Furthermore, the patients' readiness to retrospectively re-consent (treatment satisfaction) and treatment complications were recorded. RESULTS: Patient groups did not differ with regard to age, sex, number of previous dilations, and duration of follow-up (Mann-Whitney U-test, p > 0.05). 2 patients were excluded from follow-up, with one individual (HCDD) having suffered a dilation-related perforation (2.6 %) and another subject (LCDD) having not been able to re-contact. Initial and post-treatment symptom scores as well as treatment complications were similar in both treatment groups (p > 0.05). Treatment satisfaction was 90 % for the LCDD and 82 % for the HCDD group at first control, and 89 % and 87 % at second control, respectively (p > 0.05). In both patient groups, dilation therapy best improved the symptom "dysphagia" (Wilcoxon rank sum test, p < 0.05). CONCLUSIONS: Achalasia patients' satisfaction of dilation treatment is high, with their dysphagia benefiting most from therapy. Low and high compliance balloon devices did not differ from each other with regard to symptomatic efficacy and safety in forceful dilation of these individuals.

Adult↗
PubMed1999

Cardiotoxicity of the antiproliferative compound fluorouracil.

The antimetabolite fluorouracil (5-FU) is frequently administered for chemotherapy of various malignant neoplasms. The drug is well known for its adverse effects involving bone marrow, skin, mucous membranes, intestinal tract and central nervous system, whereas its cardiotoxicity is less familiar to clinicians. The pathophysiology of fluorouracil-associated cardiac adverse events is controversial and conclusions are based on clinical studies and case reports more than on solid experimental evidence. While clinical and electrocardiographic features suggest myocardial ischaemia as a main aetiological factor, possibly induced by coronary vasospasm, histomorphological and biochemical studies indicate a more direct drug-mediated cytotoxic action. Estimates of the overall incidence of fluorouracil cardiotoxicity have varied widely from 1.2 to 18% of patients. Patients may present with angina-like chest pain, cardiac arrhythmias or myocardial infarction. There is no unequivocally effective prophylaxis or treatment in this syndrome. Once fluorouracil administration is discontinued symptoms are usually reversible, although fatal events have been described. The overall mortality rate has been estimated to be between 2.2 and 13.3%. There is a high risk of relapse when patients are re-exposed to this drug following previous cardiac incidents. From the present data it is concluded that cardiotoxicity is a relevant but underestimated problem in fluorouracil treatment. Since the mechanisms of fluorouracil-associated cardiotoxicity are not yet fully understood, all patients undergoing this chemotherapy have to be carefully evaluated and monitored for cardiac risk factors and complaints. After cardiotoxic events, fluorouracil should definitely be withdrawn and replaced by an alternative antiproliferative regimen.

Antimetabolites, Antineoplastic↗
PubMed1994

[Intestinal pseudo-obstruction].

Intestinal pseudo-obstruction is a rare and heterogeneous syndrome caused by severe disorders of gastrointestinal motility. It affects the entire gastrointestinal tract or only segments, giving rise to symptoms and physical signs of a mechanical obstruction of the gut despite negative results of all imaging procedures. The disease may occur in an acute or chronic form. The acute and some of the chronic forms develop as complication of other gastrointestinal or extragastrointestinal diseases, e.g. pancreatitis or systemic sclerosis. The primary forms of chronic intestinal pseudo-obstruction are most often caused by genetic neuromuscular disorders of the gastrointestinal tract, e.g. familial visceral neuropathies. The diagnosis of intestinal pseudo-obstruction is based on the exclusion of a mechanical obstruction of the gut by fluoroscopy and endoscopy. Manometric studies may disclose the underlying disorder of gastrointestinal motility. In a few patients, results of all imaging procedures as well as motility studies are inconclusive, and laparatomy (with full thickness biopsy of the gut wall) has to be performed to exclude mechanical obstruction of the gut. Acute intestinal pseudo-obstruction is treated by elimination of the underlying intestinal or extraintestinal disease. In case of extensive colonic dilatation with imminent colonic perforation endoscopic decompression should be evaluated. Treatment of chronic pseudo-obstruction aims to correct the underlying motility disorder. Usually, restoration of normal gastrointestinal motility is attempted by prokinetic drugs, but often their effect is limited. Surgery may be helpful in the few patients in whom the disease is confined to small segments of the gut, leaving all other parts unaffected. Some patients with otherwise intractable disease may need long-term parenteral nutrition.

Acute Disease↗
PubMed1992

The effect of loperamide on anorectal function in normal healthy men.

Loperamide improves anorectal functioning in patients with diarrhea and incontinence. Loperamide reduces sensitivity of the recto-anal inhibitory reflex and increases internal anal sphincter tone. Additionally, it has an effect on rectal compliance in incontinent patients with diarrhea. We studied the effect of loperamide versus placebo at different distances from the anal verge in 18 healthy male volunteers, using standard anorectal manometry was a double-blind, two-factorial design. We found that the recto-anal inhibitory reflex is most pronounced when stimulated in regions close to the anal canal and that distention stimuli are also perceived best in that region. Both effects are counteracted by loperamide. We found no effect on internal sphincter tone or rectal compliance. These results imply a gradient of sensitivity for rectal perception and the recto-anal inhibitory reflex in healthy volunteers. Loperamide action on both mechanisms suggests a common mediator for both effects.

Adult↗
PubMed1991

[Sex behavior and knowledge about AIDS among students].

604 out of 700 students (330 females, 274 males; mean age 23.3 [19-64] years) completed a questionnaire, which was handed out by their teachers and consisted of 26 questions concerning sexual practices and knowledge about AIDS. 285 subjects were studying natural sciences, 134 arts and 185 medicine. There were significant differences between the sexes (P less than 0.01) in drug use (alcohol, cannabis), use of condoms, promiscuity and with respect to discussion of AIDS. Fewer females than males said that they occasionally used intoxicants before sex (14% vs 25%). Women also used condoms less frequently than men (23% vs 44%), although more insisted on their use if their partner declined (68% vs 58%). 55% of the men and 72% of the women were living within a stable relationship. More women (70%) than men (56%) said they would discuss AIDS before having sex with a new partner. There were significant differences between students from individual disciplines (P less than 0.01) with regard to their knowledge, use of condoms, promiscuity, and discussion of AIDS: arts students were less well informed and changed sexual partners more frequently. The same was true of students more than 30 years old. There are important differences between students with regard to their knowledge about AIDS and sexual behaviour risk factors. Educational programmes need to take this fact into account.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Epidemiology of faecal incontinence in selected patient groups.

It is known that only a minority of patients with faecal incontinence report these symptoms to their physicians. Epidemiological estimates based on medical chart data, therefore, may contain a detection bias. To evaluate such bias in epidemiological data, we evaluated prospectively the presence of faecal incontinence in selected patient groups with a proven high incidence of such symptoms and compared it to the incidence in a group of healthy controls. If the patient acknowledged faecal incontinence in the questionnaire, the medical chart was checked to see if these symptoms had been noted during previous work-up; this was used to estimate the number of unregistered cases if the epidemiological estimate is based on medical chart data. The incidence of incontinence was significantly elevated in all patient groups as compared to the controls, but only up to 5% of patients with faecal incontinence, regardless of the underlying mechanism, had these incontinence symptoms noted in the medical charts. We conclude that for the estimation of the prevalence and incidence of faecal incontinence, data from medical charts contain a detection bias which systematically underestimates the real presence of faecal incontinence.

Adult↗
PubMed1991

Anorectal manometry and defecography in the diagnosis of fecal incontinence.

We carried out anorectal manometry and defecography prospectively in 43 consecutive patients with fecal incontinence. A subgroup of 17 patients with severe incontinence was identified radiologically by a short and incompletely closed anal canal. In these patients, the anal resting pressure was significantly lower than in the rest of the group (34.9 +/- 11.4 mm Hg versus 60.0 +/- 25.7 mm Hg, respectively; p less than 0.01). The anorectal angle did not change in 24 patients during squeezing, indicating a dysfunction of the puborectalis muscle. Manometric data did not differ between this subgroup and patients with a more acute anorectal angle during voluntary sphincter contraction. This indicates that the anal pressures recorded manometrically do not reflect the function of a muscular component that is important in the maintenance of fecal continence. We conclude that anorectal manometry and defecography are complementary diagnostic tools in the investigation of patients with fecal incontinence.

Adult↗
PubMed1991

Spontaneous variation of anal "resting" pressure in healthy humans.

To investigate anal sphincter performance during sleep and after a meal, a two-channel micro-transducer probe was used for 12-h stationary recording of basal anal pressure overnight in eight healthy male volunteers. It was shown that the basal anal pressure ("resting" pressure) exhibits three distinct patterns of cyclic activity changes in all subjects: a long-term rhythm with a prominent decrease of pressure during which sleep was approximately circadian, an ultradian rhythm of approximately 20 to 40 min in length that was more prominent at night, and spontaneous relaxations of the sphincter tone occurring between 3 and 20 times per hour with the maximum frequency after breakfast. These data indicate that the anal sphincter is a dynamic structure not often at rest. Long-term anorectal manometry may be supplementary to short-term clinical evaluation of anal sphincter performance in healthy subjects as well as in patients with defecation disorders.

Activity Cycles↗
PubMed1991

[Prevalence of fecal incontinence and degree of information possessed by family physicians and health insurance].

Previous investigations have demonstrated that the prevalence of fecal incontinence ranges between 1.5 and 5% in the general population. It is, however, known that only a small portion of these patients consult a doctor for the complaints. To investigate the prevalence of fecal incontinence in Germany and to determine the reliability of epidemiological data from different sources, we distributed a questionnaire to healthy controls. In addition, two samples of patients were drawn from a local health insurance organization. Finally, the family physicians of incontinence patients from a specialized outpatient clinic which are covered by this health plan (AOK) were interviewed for whether they had noted the incontinence symptoms and had reported them to the health plan. It is shown that approximately 5% of people suffer from occasional incontinence, but that only 1.5% shown severe incontinence excluded fecal soiling. In patients with various disorders, the prevalence ranges between 0.2 and 0.35% according to health insurance data. However, in only about 75% of cases, the family physicians knew about the symptom, and in less than 50% of cases they had informed the health insurance. Epidemiological data, thus, contain a detection bias leading to an underestimation of the true prevalence of fecal incontinence.

Adult↗