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Biomedical subjects

K W Ecker

Publications and source records attributed to K W Ecker.

12 recordsLinked to original sources
PubMed1992

Endosonographic differentiation of mucosal and transmural nonspecific inflammatory bowel disease.

Thirty-seven patients with nonspecific inflammatory bowel disease were examined with an ultrasonic colonoscope and the inflammation classified as mucosal or transmural. Mucosal inflammation was characterized by preservation of the five-layer structure of the wall with thickening of the submucosa. Transmural inflammation was endosonographically defined as sectional interruption or loss of the five-layer structure. In 14 of the 37 patients a colectomy was performed. Examination of 3 of the 14 resected specimens revealed inflammation confined to the mucosa. This was consistent in all three cases with the preoperative endosonographic evaluation. Eleven of the 14 resected specimens showed sectional transmural inflammation. Ultrasonographically all of the 11 patients fulfilled the criteria for transmural inflammation, whereas endoscopic and microscopic signs were consistent with transmural inflammation in 9 of the 11. Endosonography of the colon enables definition of mucosal inflammation thus providing criteria for selection of patient for ileoanal pouch construction.

Colon↗
PubMed1991

[Ileostomy--stabilization by stapler technique].

In order to prevent nipple-sliding of the everted small bowel, conventional Brooke ileostomies in 26 patients were stabilized on both sides of the mesentery by longitudinal rows of staples. There were no early complications. With respect to historical controls with unstapled ileostomies, late complications (retraction, prolapse) could be reduced from about 16 to 0% in a median observation time of 2 years. The ileostomies were stable in size and form and therefore appliances were facilitated.

Crohn Disease↗
PubMed1991

[Changes in cell-mediated immune reactions in Crohn's disease].

In a prospective study the effect on cell-mediated immunity (Mérieux-Multitest), nutritional state and parameters of inflammation was compared in conservatively (n = 21) and surgically (n = 20) treated patients with Crohn's disease. Before therapy both groups showed a significantly lower immune response compared with healthy controls. The therapeutical effect was similar in both groups concerning normalization of parameters of inflammation, CDAI and state of nutrition. In contrast, normalization of immune response in skin test was only observed after bowel resection, while conservatively treated patients remained in hyperergy. In conclusion, the impairment of the cell mediated immunity in Crohn's disease must be secondary. Excluding patients with steroid therapy there was no correlation between preoperative annergy or hyperergy and postoperative complications.

Adult↗
PubMed1991

[Complete reconstruction of the natural anus in complicated rectal prolapse].

In a 44-year old woman a severe case of prolapse of the rectum was complicated by complete incontinence and rectal stenosis. Continence was restored by colo-anal anastomosis between an oral smooth-muscle-plasty and the anal skin introduced in a newly created anal canal by a distal voluntary muscle-plasty. The successfully applied one-stage technique in reestablishing non-voluntary and voluntary muscular continence is described in detail.

Adult↗
PubMed1985

Tests for the absorption of 75Se-labelled homocholic acid conjugated with taurine (75Se-HCAT).

The absorption of selenomethionine Se 75-labelled homocholic acid conjugated with taurine (75-SE-HCAT) was tested in 46 patients. Retention measurements using (1) an uncollimated gamma camera and (2) a measuring arrangement similar to a human-body counter were compared in order to obtain a quantitative assessment of the absorption capacity of the terminal ileum for bile acids. The retention curve obtained after the oral administration of the 75Se-labelled bile-acid analogue showed a monoexponential decline; in the case of unimpaired absorption, the half-life was greater than 2.5 days. When more than 30 cm of the ileum had been eliminated by inflammatory infection or resection, the measured half-life was below 0.5 days due to malabsorption. We also performed a quantitative determination of the hepatic secretion of 75-Se-HCAT into the gall bladder. If more than 80% of the activity administered is found in the gall bladder, disturbed absorption of bile acids in the terminal ileum can be excluded. Values smaller than 80%, however, do not provide proof of disturbed absorption.

Crohn Disease↗
PubMedDate not supplied

Optimization of isolated hyperthermic limb perfusion.

During isolated limb perfusion, we studied the impact of limb temperature on the concentration of cytostatic drugs in the tissue to identify a possible selective absorption of cytostatic agents by the various tissues. Ten consecutive patients with malignant melanoma were randomly divided into two different groups and perfused with 1 mg cisplatin per kg body weight. In one group the cytostatic agents were injected under hyperthermic conditions (39.5 degrees C) and in the other group under normothermic conditions (37 degrees C). The platinum concentration in the melanoma was twice as high in the hyperthermic group as in the group under normothermic conditions. In the tumor-free tissue the platinum concentration decreased with temperature while it remained constant in the musculature. This selective concentration of cisplatin in the tumor under hyperthermic conditions is accompanied by fewer side effects. Follow-up will show whether the oncological results will be improved in the hyperthermic conditions as one might expect.

Chemotherapy, Cancer, Regional Perfusion↗
PubMedDate not supplied

Improved stabilization of conventional (Brooke) ileostomies with the stapler technique.

The rate of functional complications of conventional (Brooke) ileostomy is high and endangers the complete postoperative rehabilitation of the patients. About half of these complications (retraction with/without stenosis, intermittent recession, and prolapse) occur within the classical prominent stoma and are caused by displacement of the serosa surfaces. We have stabilized conventional ileostomies in 39 patients with rows of staples placed paramesenterially and longitudinally. The ileum was everted in the classical way in the primary construction of ileostomies in 19 patients. On the other hand, in 11 patients the prominence of the stoma was established by pulling the ileum out through the previously plane-sutured stoma. In addition, 9 patients with ileostomies which were not primarily stabilized were corrected with the stapler technique to treat complications. With follow-up ranging from 0.2 years to 4.2 years, there have been no complications due to sliding of the nipple in these 39 patients. In contrast, there were complications in 37% of 38 patients with non-stabilized ileostomies with follow-up to the second postoperative year. It was more easily reproducible, more exact, and less traumatic to create the stoma prominence by pulling the intestine out from a primarily plane stoma than with classical eversion. With use of the stapler in repairing complications, local ileostomy constructions were no longer required in every second patient. Consequently, a Brooke ileostomy can be constructed more easily with the stapler technique, ensuring long-term function or restoration of function.

Humans↗