Biomedical subjects

M Sailer

Publications and source records attributed to M Sailer.

At least 19 recordsLinked to original sources

PubMed2005

[Nononcologic abdominal surgery in the elderly].

Due to rising life expectancy of the population, the proportion of elderly patients requiring surgery is rising as well. Present aspects of selected, typical, nononcologic diseases of elderly people are discussed. The key to success in their treatment is not to consider primarily the patient's calendrical age but to assess the individual profile of risk factors on the basis of comorbidities. The kind, extent, and timing of an operation has to be based on this assessment. For the treatment of acute diseases (e.g., complicated ulcera, cholecystitis, appendicitis, mesenteric ischemia, and diverticulitis), a rapid and efficacious diagnostic algorithm is essential that takes into account the reduced functional reserve of old people. Constructive interdisciplinary cooperation and minimally invasive techniques play dominant roles in both diagnosis and therapy. Given these prerequisites, there is no reason to withhold surgical intervention from elderly patients.

Abdomen↗

PubMed2005

The BDNF-Val66Met polymorphism: implications for susceptibility to multiple sclerosis and severity of disease.

Neurodegeneration following inflammatory injury is considered to be a pathological correlate of irreversible disability in patients with multiple sclerosis. The availability of neurotrophins could influence the probability or rate of disease progression and the time of onset. The BDNF-Val66Met-polymorphism leads to altered intracellular transport and secretion of BDNF, and is thus a logical candidate for a gene that influences susceptibility and, more specifically, the clinical course of multiple sclerosis. In order to test this hypothesis we genotyped the polymorphism in 951 UK multiple sclerosis trio families, but found no evidence for association before (p=0.63) or after stratification for clinical course (p=0.73).

Brain-Derived Neurotrophic Factor↗

PubMed2005

[Anastomotic fistula. Complication caused by surgery].

Chronic anastomotic fistula are an expression of a complication after anastomoses caused by surgery. The cause of this is diverse and reaches from incorrect seam technology, over factors of the comorbidity up to the fateful process. All regions from the esophagus to the rectum and, in addition, the biliary and pancreatic ducts can be affected. To evaluate the general problem localization diagnostics are necessary, whereby different endoscopic, radiological and combining techniques are being applied. The treatment of fistulas contains therapies of conservative, conservatively medicamentous over the intervention in endoscopic management up to the surgical treatment. In most cases the treatment of anastomotic fistula require an individual patient-fair therapy; exceptions are the pancreatic fistula.

Anastomosis, Surgical↗

PubMed2004

Endoscopic ultrasound-guided transrectal aspiration of pelvic fluid collections.

BACKGROUND: The aim of this study was to evaluate the feasibility, safety, and diagnostic accuracy of endorectal ultrasound-guided aspiration and drainage of pelvic fluid collections. METHODS: All patients who underwent endorectal ultrasound-guided aspiration and/or drainage of pelvic fluid collections were included in this prospective study. Patients were prepared using bowel lavage and a single-dose antibiotic combination. The procedure was carried out in the lithotomy position usually without sedation. All aspirates were examined microbiologically and/or cytologically. RESULTS: Twenty-nine patients [18 females and 11 males; median age, 67 years (range, 18-79)] underwent 33 endosonographic controlled aspirations. No procedure-related complications were encountered. In 22 cases (76%) the lesions were encountered following a surgical procedure. Fluid amounts varied between 5 and 750 ml. Fluids were sterile in 14 cases (42%). These fluid collections were hematomas, seromas, peritoneal cysts, and a mucocele. Microorganisms were found in the remaining 19 aspirations (58%), i.e., abscesses (n = 16) and infected hematomas (n = 3). A transrectal (n = 14) or transvaginal (n = 2) drainage catheter was placed in 16 patients under endosonographic guidance. Only two patients required a subsequent laparotomy for definitive treatment of their septic focus, whereas all other patients could be treated successfully by this conservative approach. CONCLUSION: Endoscopic ultrasound-guided transrectal aspiration and drainage of pelvic fluid collections is a safe method with a favorable outcome because it avoids unnecessary operations in selected patients.

Adult↗

PubMed2004

[Diagnosis and treatment of chronic anastomotic fistulas].

Treatment of anastomotic fistulas generally implies an individualized concept. The origin of these complications is multifactorial and comprises such factors as primary operation, oncologic situation, comorbidity, and patient age as well as fistula-specific considerations such as anatomic localization, secretion volume, etc. In the case of high-output fistulas, it is of great importance to counteract fluid and electrolyte imbalances. Furthermore, skin maceration due to aggressive secretion needs to be averted. Therapeutic options include operative and endoscopic interventions. Octreotide plays a role in high-output and pancreatic fistulas. Any underlying ailment (e.g., Crohn's disease) requires an optimal disease-specific treatment which characterizes an interdisciplinary approach to such fistulas. The following article discusses general and site-specific considerations in the diagnosis and treatment of anastomotic fistulas.

Anastomosis, Surgical↗

PubMed2004

Escalating immunotherapy of multiple sclerosis--new aspects and practical application.

Recent clinical studies in multiple sclerosis (MS) provide new data on the treatment of clinically isolated syndromes, on secondary progression, on direct comparison of immunomodulatory treatments and on dosing issues. All these studies have important implications for the optimized care of MS patients. The multiple sclerosis therapy consensus group (MSTCG) critically evaluated the available data and provides recommendations for the application of immunoprophylactic therapies. Initiation of treatment after the first relapse may be indicated if there is clear evidence on MRI for subclinical dissemination of disease. Recent trials show that the efficacy of interferon beta treatment is more likely if patients in the secondary progressive phase of the disease still have superimposed bouts or other indicators of inflammatory disease activity than without having them. There are now data available, which suggest a possible dose-effect relation for recombinant beta-interferons. These studies have to be interpreted with caution, as some potentially important issues in the design of these studies (e. g. maintenance of blinding in the clinical part of the study) were not adequately addressed. A meta-analysis of selected interferon trials has been published challenging the value of recombinant IFN beta in MS. The pitfalls of that report are discussed in the present review as are other issues relevant to treatment including the new definition of MS, the problem of treatment failure and the impact of cost-effectiveness analyses. The MSTCG panel recommends that the new diagnostic criteria proposed by McDonald et al. should be applied if immunoprophylactic treatment is being considered. The use of standardized clinical documentation is now generally proposed to facilitate the systematic evaluation of individual patients over time and to allow retrospective evaluations in different patient cohorts. This in turn may help in formulating recommendations for the application of innovative products to patients and to health care providers. Moreover, in long-term treated patients, secondary treatment failure should be identified by pre-planned follow-up examinations, and other treatment options should then be considered.

Clinical Trials as Topic↗

PubMed2004

Primary carnitine deficiency: adult onset lipid storage myopathy with a mild clinical course.

We studied two adult patients with myalgia and muscular fatigability during prolonged physical exercise. Serum creatine kinase was increased and muscle biopsy revealed a lipid storage myopathy affecting predominantly the type I fibres. Skeletal muscle carnitine content was reduced to 15% and 21% of the normal mean values, while serum carnitine levels were either normal or decreased. Four months of oral therapy with L-carnitine (3 g per day) resolved the clinical symptoms completely in both patients, and a subsequent muscle biopsy confirmed a marked reduction of lipid storage, along with increased muscle carnitine levels. The analysis of renal carnitine excretion and the exclusion of possible secondary carnitine deficiencies in both patients are compatible with mild defects of the carnitine transporter in one patient and of carnitine biosynthesis in the other. Since myalgia and muscular fatigue are frequent but unspecified complaints of otherwise clinically unremarkable adult patients, it is important to identify myopathies associated with primary carnitine deficiency because they may be amenable to treatment.

Adult↗

PubMed2004

A teaching model for endorectal ultrasound-guided biopsy and drainage of pararectal tumors.

For determination of histology of small solid and microbiology of liquid pararectal tumors there is no other method than endorectal ultrasound-guided biopsy. Also for therapy of abscesses or seromas drainage application is possible. With this technique an operation may be prevented. In awareness of possible complications such as major injury of rectal wall, bleeding, persistent fistula and sepsis, teaching and training in this method is consequently necessary. For a training program a lifelike model of the rectum was developed. It has been used by 780 participants in 20 training courses organized by the Surgical Department of University Hospital Würzburg.

Abscess↗

PubMed2004

[Usefulness of anal endosonography in the assessment of fistula-in-ano].

AIM: The purpose of the present study was to define the diagnostic value of anal endosonography in the diagnostic work-up of fistula-in-ano. METHODS: A retrospective study was carried out on 191 consecutive patients (m: 121; f: 70; mean age: 44.0 +/- 12.5 years; range: 0.5-77 years) who were diagnosed to suffer from fistula-in-ano by performing anal endosonography in an outpatient setting. All images were obtained with a Combison 310A ultrasound scanner (Kretz GmbH, Zipf, Osterreich) and 5-Mhz and 7.5-MHz transducer. 131 patients underwent surgery. According to the endosonographic findings fistulas were classified as transsphincteric in 44 %, intersphincteric in 22 %, subanodermal in 16 %, anovaginal in 8 %, suprasphincteric in 5 %, extrasphincteric in 1 % and others in 4 %. RESULTS: In 125 patients (95 %) the preoperative diagnosis was confirmed intraoperatively. This cohort included 12 patients with a complex fistula system. In only 6 patients the preoperative ultrasound finding was misinterpreted. CONCLUSION: In conclusion this study has shown that anal endosonography is a useful and reliable tool in the preoperative evaluation of uncomplicated and complicated anorectal fistulas.

Adolescent↗

PubMed2004

[Perineal hernia: an undescribed complication following operative repair of vault vaginal prolaps].

The presented case reports the treatment of a 80-year-old V gravida IV para suffering from a large perineal hernia and rectocele after vaginal hysterectomy and subsequently performed threefold colpocleisis due to recurrent vault vaginal prolaps.[nl]Since perioperative morbidity and mortality of geriatric patients differ not significantly from thoses of younger women age should not be used as an argument to withhold elderly organ preserving operative strategies with low recurrence rates.

Aged↗

PubMed2003

[Tumescent local anesthesia in proctologic surgery].

INTRODUCTION: Tumescent local anesthesia (TLA) was introduced to facilitate liposuction and other procedures mainly in plastic surgery. The aim of our study was to evaluate if this new technique can also be safely applied in proctologic surgery. METHODS: The following 50 proctologic procedures were performed using TLA as day surgery cases: perianal vein thrombectomy (n=15), subanodermal fistula resection (n=7), anal polyp resection (n=7), fissurectomy ( n=6), perianal abscess revision (n=6), excision of anal skin tags (n=3), hemorrhoidectomy for thrombosed piles (n=3), intersphincteric fistula extirpation (n=1), pilonidal sinus (n=1), and perianal tumor excision (n=1). The subcutaneously infused solution contained 200 ml of Ringer's solution, 50 ml of 2% Mepivacain, and 2.5 ml of epinephrine diluted 1:10,000. RESULTS: During an average application time of 14.3+/-4.9 min, a mean of 93.1+/-40.7 ml tumescent solution was infused. This dosage resulted in complete pain relief after 18.3+/-5.0 min. Local anesthesia was maintained up to 14 h postoperatively, with a mean duration of 6.7+/-1.9 h. Two patients developed moderate hematomas which required no further treatment. CONCLUSIONS: Our pilot study demonstrates that slow infusion tumescent local anesthesia can be widely and safely applied in proctologic surgery and enables the performance of these procedures on an outpatient basis.

Abscess↗

PubMed2003

[Percutaneous transhepatic retrieval of an intraoperatively displaced biliary stent].

Biliary stents play an important role in the treatment of jaundice due to malignant and/or benign diseases of the bile duct. Biliary stents are primarily introduced endoscopically whereas the percutaneous transhepatic technique is employed after endoscopic failure. Proximal and distal displacement or migration is a rare complication, but there is a risk of considerable morbidity and mortality, so that the extraction of the prosthesis is recommended in these cases. Again, endoscopic removal is the approach of choice. For stent retrieval multiple techniques have been described, including Dormia basket, special forceps, Fogarty balloon catheter, ball tip catheter and loop catheter. Endoscopic recovery often uses a combination of these techniques reaching a success rate of 90%. However, in patients following hepaticojejunostomy or Bilroth II procedure an endoscopic retrieval cannot be performed for obvious technical reasons. Consequently, percutaneous transhepatic stent removal must be considered. Ensuring a correct technique transhepatic removal is equally successful and safe, thus eliminating the risks of a surgical procedure.

Adult↗

PubMed2003

[Which functional diagnostic tools do German coloproctologists favour?].

AIM: We tried to evaluate the role of anorectal functional diagnostic tools according to the judgement of German coloproctologists. METHOD: Questionnaires concerning accuracy of different diagnostic tests were sent to 585 physicians specialized in coloproctology. RESULTS: 261 (44.6 %) completed forms were returned. An analysis of the answers revealed that endorectal sonography is widely (73 %) regarded as useful and reliable diagnostic tool. Though manometry is still frequently used, only 50.5 % of the coloproctologists made their decision concerning the further treatment depending on the results of this method. Other radiologic methods as defecography and colon transit time are still regularly performed, though video-defecography is not accepted by most coloproctologists. Neurological investigations as pudendal nerve terminal latency, surface-EMG and needle-EMG are exclusively applied in specialized departments. DISCUSSION: Regarding the variety of diagnostic tools and its different appraisal a consensus should be defined. The usefulness of neurological examination techniques needs to be clarified before their performance can be recommended for a wide-spread routine work up.

Colonic Diseases↗

PubMed2002

Randomized clinical trial comparing quality of life after straight and pouch coloanal reconstruction.

BACKGROUND: Functional results after rectal resection with straight coloanal anastomosis are poor. While most functional aspects are improved with coloanal J pouch anastomosis, it is still unclear whether this translates into better quality of life. The aim of this trial was to investigate health-related quality of life as a primary endpoint in patients undergoing sphincter-saving rectal resection. METHODS: Sixty-four patients were randomized to either straight (n = 32) or coloanal J pouch (n = 32) anastomosis. Patients were studied before operation, at the time of stoma reversal and at 3-month intervals for 1 year thereafter. Quality of life was measured using two generic (Gastrointestinal Quality of Life Index and European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30) and one disease-specific (EORTC QLQ-CR38) instruments. Functional results using a standardized score as well as manometric variables were recorded. RESULTS: Thirty-nine patients (19 with a pouch and 20 with a straight anastomosis) completed the trial. There was a marked difference between the two groups with regard to quality of life profile. Patients with a pouch reconstruction had a significantly better quality of life, particularly in the early postoperative period. CONCLUSION: Patients undergoing low anterior rectal resection and coloanal J pouch reconstruction may expect not only better functional results but also an improved quality of life in the early months after surgery compared with patients who receive a straight coloanal anastomosis.

Aged↗

PubMed2001

Effect of creatine supplementation on metabolite levels in ALS motor cortices.

Mitochondrial pathology is an early observation in motor neurons and skeletal muscle of patients with amyotrophic lateral sclerosis (ALS). To clarify the relevance of this finding, we determined the effects of a 1-month oral administration of creatine on (1)H NMR-visible metabolites in the motor cortices of 15 controls and 15 patients with sporadic ALS, most of whom had mitochondrial pathology in skeletal muscle. In the motor cortex of the ALS group the N-acetylaspartate (NAA)/creatine (Cr(t)) metabolite ratio was lower than in our control group, indicating NAA loss. Upon creatine supplementation we observed in the controls a decline in the NAA/Cr(t), NAA/choline (Cho), glutamate + glutamine (Glx)/Cr(t), and Glx/Cho metabolite ratios. In contrast, in the ALS patient group the NAA/Cr(t) and the NAA/Cho metabolite ratios remained unchanged, while the Glx/Cr(t) and Glx/Cho metabolite ratios decreased. These data are compatible with the interpretation that creatine supplementation causes an increase in the diminished NAA levels in ALS motor cortex as well as an increase of choline levels in both ALS and control motor cortices. Because NAA is synthesized by mitochondria in an energy-dependent manner and the NAA/Cho metabolite ratios in the ALS motor cortices were found to be correlated to the degree of mitochondrial pathology in ALS skeletal muscle, our results can be explained by a deficiency of enzymes of mitochondrial respiratory chain in the ALS motor cortex which might affect motor neuron survival.

Adult↗

PubMed2001

Intracavitary afterloading boost in anal canal carcinoma. Results, function and quality of life.

BACKGROUND: First clinical data on a new intracavitary afterloading boost method for anal canal carcinoma is reported. PATIENTS AND METHODS: 20 consecutive patients (T1 5%, T2 70%, T3 20%, T4 5%; N0 75%, N1 10%, N2 15%; all M0) treated with external beam pelvic radiotherapy (median dose 56 Gy, range 46-64 Gy), simultaneous 5-FU and mitomycin (in 75%) and an intracavitary afterloading boost (one or two fractions of 5 Gy at 5 mm depth) were analyzed after a mean +/- SD follow-up for living patients of 4.4 +/- 2.1 years. Quality of Life (QoL) and anorectal manometry parameters were assessed in ten colostomy-free survivors. RESULTS: Overall, recurrence-free and colostomy-free survival at 5 years were 84%, 79% and 69%, respectively. No death was tumor-related. The only local failure was successfully salvaged by local excision. All three colostomies were performed for toxicity. Resting pressure and maximum squeeze pressure of the anal sphincter were reduced by 51% and 71%, as compared with control subjects, but quality of life was similar compared to healthy volunteers. CONCLUSION: The described regimen is highly effective but associated with increased toxicity.

Aged↗

PubMed2001

Influence of cerebral lesion volume and lesion distribution on event-related brain potentials in multiple sclerosis.

Neurocognitive involvement in multiple sclerosis (MS) is heterogeneous with some authors suggesting a frontal pattern in patients with predominantly frontal lesions. To assess the relationship between the distribution of lesions and two cognitive components (visual N2, auditory P3a) of the event-related brain potential (ERP) receiving contributions from frontal lobe structures, we performed a combined ERP and magnetic resonance imaging (MRI) study. Thirty-four MS patients were assigned to "low lesion volume, (LLV)"(n = 12),"high lesion volume,(HLV)"(n = 12) and"frontal lesion volume, (FLV)" (n = 10) groups according to lesion volume and distribution on T2-weighted MRI-scans of the brain. ERPs in visual and auditory classification tasks as well as neuropsychological tests were carried out in patients and control subjects (n = 15). The index for automatic feature registration, the N2 component with its mainly frontal contribution in the visual task, was significantly reduced in amplitude in the FLV and HLV groups (both p < 0.01 vs. controls). Moreover its amplitude correlated with lesion volume (r=0.64, p < 0.001). In contrast neither P3a nor P3b subcomponents with a multiple generator nature in the auditory task varied systematically with lesion volume or distribution. Total lesion volume rather than predominant lesion arrangement appears to be the most important factor in neurocognitive changes in MS. This is most consistent with the view that MS lesions lead to partial disconnections within widespread cortical networks which in turn produce a pattern of neuropsychological deficits that reflect total lesion load more than lesion distribution.

Adult↗

PubMed2001

Serum inflammatory markers and clinical/MRI markers of disease progression in multiple sclerosis.

The aim of this study was to assess whether mean serum levels of inflammatory markers when measured serially correlate with disease progression or putative MRI markers of axonal loss in a cohort of well-characterised multiple sclerosis (MS) patients. Serial serum levels of soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), nitric oxide metabolites nitrate and nitrite (NOx), C-reactive protein (CRP), neopterin and tumour necrosis factor alpha (TNF-alpha) were measured in 29 MS patients, 13 with a relapsing remitting (RR) and 16 with a secondary progressive (SP) course, who were participating in a phase II clinical trial of anti-CD4 therapy. Short-term whole blood stimulated TNF-alpha production was also measured. Patients were studied 12 times over an 18-month period. MRI variables included the number and volume of Gd-enhancing lesions and the change in T2-hyperintense, T1-hypointense lesions and cerebral volume between the baseline and exit studies. Disease progression required a sustained change in the EDSS. There was no correlation between mean levels of inflammatory markers over the study period and disease progression or changes in any of the MRI measures. However, mean sICAM-1 levels from the first 6 months of the study were higher in patients who progressed during the study than in those that did not (443 (SD439) vs. 235 (SD162) ng/mL, p=0.05). Mean levels of NOx were significantly higher in patients with RR MS than in patients with SP disease (59.1 micromol/L (SD 12.8) vs. 48.7 micromol/L (SD 11.9), p=0.02). Patients with either a single relapse or no relapse had significantly higher NOx levels than to patients with multiple relapses during the 18 month follow-up (59.0 micromol/L (SD 12.3) vs. 47.9 micromol/L (SD 12.0), p=0.02). The mean levels of the other inflammatory markers did not correlate with disease course or relapse-rate. Serum levels of many inflammatory markers do not correlate with short-term disease progression. Some of the data suggest that the effects of inflammation on disease progression are delayed. In addition raised levels of serum nitric oxide metabolites are associated with a lower number of clinical relapses and a non-progressive disease course. These findings, although preliminary, pose interesting questions on the role of nitric oxide in the pathogenesis of MS. Inducible NO production in the early stages of the disease may be beneficial.

Adult↗