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Biomedical subjects

M Stelzner

Publications and source records attributed to M Stelzner.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Gastrointestinal amyloidosis: differential diagnosis and indications for surgical therapy].

The diagnosis of gastrointestinal amyloidosis may be difficult for both the radiologist and the examining surgeon because clinical symptoms are often uncharacteristic. Upper gastrointestinal series may show stenosing submucosal masses in the esophagus or gastric antrum with diminished peristalsis and pliability mimicking malignancies. With small bowel involvement, diminished motility and segmental or complete distension, a prolonged transit time, and eventually obstruction are common findings. In the present study, we report four cases of gastrointestinal amyloidosis and review the indications for operative treatment. Surgery should be avoided for abdominal pseudo-obstruction and but may be indicated in patients with gastrointestinal bleeding, perforation or other severe complications. The postoperative course is characterized by impaired wound healing, a high rate of heart and kidney failures, and considerable perioperative mortality. Thus, results are frequently unsatisfactory.

Aged↗
PubMed1990

Adaptive changes in ileal mucosal nutrient transport following colectomy and endorectal ileal pull-through with ileal reservoir.

To study ileal mucosal function when used in an ileal reservoir or ileostomy, eight dogs underwent colectomy and endorectal ileal pull-through with creation of a lateral ileal reservoir. Ileal mucosal biopsy specimens were obtained at the initial operation, from the ileostomy and dormant ileal reservoir at the time of ileostomy closure, and from the reservoir 3 months later. Rates of uptake for four different substrates were determined by radioactive absorption techniques. Absorption of carbohydrates, amino acids, and bile acids was markedly decreased and of short-chain fatty acid mildly reduced in ileal reservoir mucosa compared with normal ileum, largely owing to a decrease in reservoir absorptive surface area from flattened villi. Reservoir uptake of the substrates evaluated within 3 months after operation was similar to that for normal colonic mucosa. Uptake of all measured substrates from ileostomy mucosa approximated that of normal ileum. The use of short ileal reservoirs and the avoidance of stasis may favor reduced bacterial growth and increased nutrient absorption.

Adaptation, Physiological↗
PubMed1990

Acute ileus from steroid withdrawal simulating intestinal obstruction after surgery for ulcerative colitis.

Sixty of 127 prednisone-dependent patients with ulcerative colitis who underwent colectomy and endorectal ileal pull-through with ileal reservoir and subsequent laparotomy with ileostomy closure (254 operations) during a 4-year period developed 95 episodes of intestinal obstruction during the early post-operative period. Acute ileus due to steroid withdrawal caused symptoms of intestinal obstruction in 43 patients (76 episodes), whereas true mechanical small-bowel obstruction occurred in only 17 patients (19 episodes). Symptoms of both conditions were similar; however, hypoactive bowel sounds, acute onset of emotional depression, no evidence of obstruction on radiologic contrast stomatogram or enema, and prompt relief of symptoms within 4 hours after intravenous administration of hydrocortisone acetate distinguished acute steroid withdrawal. Since ileus from acute steroid withdrawal occurred four times as frequently as mechanical small-bowel obstruction, prompt recognition and treatment should appreciably reduce postoperative morbidity and hospital costs.

Adolescent↗
PubMed1990

Surgical therapy of oesophageal carcinoma.

During the past 10 years, postoperative mortality associated with surgical treatment of oesophageal carcinoma has been reduced by one-half. However, it appears that all efforts to improve long-term survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-six of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Recent studies suggest that seven of them will die from postoperative complications and 49 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 27 will survive the first, 12 the second, and ten the fifth year. Although it may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.

Combined Modality Therapy↗
PubMed1990

Changes in mucosal nutrient transport in small and large ileal reservoirs after endorectal ileal pullthrough.

It has been hypothesized that, following colectomy and endorectal ileal pullthrough with ileal reservoir (PTR), reservoir tissue might lose some of its normal nutrient transport capacity and assume properties of the colon. Whether reservoir size influences the expected alterations in normal mucosal absorption and thus contributes to changes in intraluminal ecology has not previously been investigated. To study this, the everted intestinal sleeve technique was used to measure uptake of four nutrients in two groups of dogs who underwent PTR: five with a small (5 cm) lateral reservoir and five with a large (18 cm) reservoir. Mucosal samples were taken from normal ileum and colon and from reservoirs 3 months postoperation. Active uptake of carbohydrates (glucose), amino acids (proline), and bile acids (taurocholate) and passive uptake of short chain fatty acids (propionate) were markedly decreased in mucosa of both reservoir sizes compared to normal ileum (P less than 0.05, t test) and more closely approximated that of normal colon. Uptake of glucose, proline, and taurocholate in large reservoirs was significantly less than that in small reservoirs (P less than 0.05). We conclude that (1) ileal reservoir mucosa has a significantly reduced capacity for nutrient uptake, (2) ileal mucosa in small reservoirs shows higher nutrient uptake rates than mucosa in large reservoirs, and (3) short, well-emptying reservoirs appear best suited to optimizing the intraluminal environment and thus enhance reservoir function when performing PTR.

Animals↗
PubMed1990

Nephrolithiasis and urine ion changes in ulcerative colitis patients undergoing colectomy and endorectal ileal pullthrough.

Nephrolithiasis occurs in 5 to 13% of patients with ulcerative colitis (UC) who undergo colectomy and abdominal ileostomy, presumably from chronic dehydration and urinary concentration. Whether endorectal ileal pullthrough with ileal reservoir (PTR) changes the incidence of stones (primarily calcium oxalate) after colectomy is not known. Urinary excretion of Na2+, K+, Ca2+, Mg2+, phosphate, urate, oxalate, and citrate was measured in a prospective study of 12 UC patients undergoing PTR with temporary end ileostomy. Twenty-four-hour urine samples were obtained before colectomy (t1), after colectomy but before ileostomy closure (t2), and 5 months after ileostomy closure (t3). Urine volumes decreased from 831 +/- 101 cc (mean +/- SE) at t1 to 715 +/- 101 cc at t2 and then increased to 1278 +/- 421 cc at t3 (significant, with P less than 0.01 by t test). Urinary excretions of Mg2+, oxalate, and citrate were low in UC patients compared to those in controls (15 healthy adult volunteers). Excretion of Ca2+ increased significantly following temporary ileostomy while excretion of Mg2+ fell. Excretion of Ca2+ fell and excretion of Mg2+ and citrate increased following PTR. We conclude that PTR patients have increased urine volumes and urinary ion changes known to decrease the risk of developing renal stones.

Adolescent↗
PubMed1990

Assessment of anorectal function after mucosal proctectomy and endorectal ileal pullthrough for ulcerative colitis.

Twenty-one consecutive patients (10 male and 11 female) with ulcerative colitis who underwent colectomy, mucosal proctectomy, and endorectal ileal pullthrough with ileal reservoir were examined by serial anorectal sphincter measurements. Values were recorded before operation, after operation, and on two occasions during a 6-month period after ileostomy closure. Anal sphincter pressures and rectal ampullary volume measurements were performed using a new, simplified recording instrument. The anal resting pressure was elevated for both male and female patients preoperatively but decreased to levels slightly below normal control values after the pullthrough procedure. The maximal squeeze pressure was markedly elevated for both male and female patients preoperatively but decreased to levels near normal controls postoperation and remained at this level during the entire period of study. The rectal sensitivity threshold and rectal volume tolerance were markedly decreased preoperatively and appeared to correlate closely with the severity of inflammatory disease in the rectum. After the operation the maximal tolerance volume increased in direct relation with enlargement of the ileal reservoir and was associated with a slight, but definite, decrease in stool frequency. This study confirms the view that although mucosal proctectomy may have mildly adverse effects on anal sphincter function, this impairment is well compensated in most patients. Abnormalities recorded preoperatively are likely to persist after the pullthrough procedure. More than 90% of patients consider themselves continent after long-term follow-up evaluation.

Adolescent↗
PubMed1989

The endorectal ileal pullthrough procedure in patients with ulcerative colitis and familial polyposis with carcinoma.

Since 1977, 196 patients (177 with ulcerative colitis and 19 with familial polyposis) have undergone colectomy, mucosal proctectomy and endorectal ileal pull-through with or without an ileal reservoir (PTR) at UCLA Medical Center. Fourteen of the patients (7.1 per cent) had carcinoma of the colon or rectum at the time of operation; 12 had colitis and two, polyposis. Another 40 patients had mucosal dysplasia. Only five of the 14 patients with carcinoma were diagnosed before operation despite close surveillance by gastroenterologists. The mean duration of colitis before the diagnosis of carcinoma was made was 17 years; the mean age that the carcinoma was identified was 38 years. Eleven of the 12 patients with colitis had universal involvement. Two patients with colitis and carcinoma who underwent colectomy and PTR died a mean of 30.5 months postoperatively of metastatic disease. Twelve patients with carcinoma (ten with colitis and two with polyposis) are alive a mean of 29 months postcolectomy and PTR; two of these have received chemotherapy. The low mortality (0.4 per cent) and good clinical results after colectomy and the PTR procedure and the unexpectedly high incidence of carcinoma and mucosal dysplasia among patients referred for operation suggest that surgical treatment should be considered at an earlier stage than the current general practice, particularly in patients at high risk (mucosal dysplasia, pancolitis and duration of more than ten years).

Adenocarcinoma↗
PubMed1988

Experience with the endorectal ileal pullthrough with lateral reservoir for ulcerative colitis and polyposis.

Since 1977, 184 patients with colitis or polyposis underwent colectomy with endorectal ileal pullthrough in two stages with a temporary ileostomy. Five had an S reservoir, three had a J reservoir, and 15 had no reservoir; 97 patients had a lateral reservoir constructed at the second operation and 64 had one constructed at the first operation. Ten patients with no reservoir and one with a J reservoir underwent conversion to a lateral reservoir because of stool frequency. Three patients with an S reservoir and six (3.5%) of 172 patients with a lateral reservoir underwent a permanent ileostomy. Over 65% of complications occurred in the first 50 patients. Late reservoir shortening was necessary in 34 patients. Of the last 110 patients, 107 are functioning well with a mean of six bowel movements per day. A short lateral reservoir (less than 15 cm) constructed at the first operation produces the fewest complications and best results.

Adenomatous Polyposis Coli↗
PubMed1988

Significance of reservoir length in the endorectal ileal pullthrough with ileal reservoir.

Ileal reservoirs have been used almost routinely in conjunction with total colectomy and the endorectal ileal pullthrough procedure for ulcerative colitis and familial polyposis. Of 153 patients who underwent surgery at UCLA Medical Center during the past seven years, a comparison was made between 14 patients with an initial reservoir length of greater than 30 cm (large) and 54 patients with a short reservoir (14 to 20 cm). Although patients with long reservoirs had a low stool frequency in the first postoperative year, there was a subsequent increase. During the first two postoperative years, six (43%) of 14 patients developed reservoir enlargement with secondary pouchitis and diarrhea, which severely limited their activities, finally requiring partial resection. Only one of the 14 patients with short reservoirs who underwent surgery more than two years previously had a resection. Complications requiring operative treatment were more than five times greater in patients with long reservoirs. All patients with shortened reservoirs experienced dramatic improvement in their clinical course within one month. Ileal reservoirs of 14 to 16 cm in length appear to provide long-term, excellent clinical function, with an incidence of pouchitis of less than 5%. Symptoms in patients with large reservoirs may be greatly improved by reservoir shortening.

Adenomatous Polyposis Coli↗
PubMed1988

Construction of an ileal reservoir in patients with a previous straight endorectal ileal pull-through.

A decade has passed since Martin and associates presented the first series of endorectal ileal pull-through (PT) procedures with straight ileoanal anastomosis for treatment of ulcerative colitis and polyposis. During the ensuing years, several medical centers have reported their results using the PT. Although some children have experienced good results, the majority of adults and children have had severe problems associated with high stool frequency, urgency, and incontinence. Between 1977 and 1987, 12 patients underwent colectomy and straight PT for ulcerative colitis or familial polyposis under the direction of a single surgeon. In this group, the average number of stools varied from six to 45 movements per 24 hours (mean, 18). In seven patients, high stool frequency (mean, 24 per 24 hours), partial fecal incontinence, and urgency that led to moderate to severe limitation in physical, social, work, and sexual activities made it necessary to convert the straight PT to an ileal reservoir. For each of these patients, the ileal PT segment was separated from the rectal muscle cuff, a lateral isoperistaltic reservoir was constructed, and the ileoanal anastomosis was re-established in a one-stage operation. One additional patient decided to return to a conventional ileostomy. All seven patients who underwent conversion to a PT with reservoir had no major complications, and each improved markedly in their clinical status. Daytime stool frequency was reduced by a mean of approximately 50%, whereas nocturnal frequency was decreased by a mean of 60%. Incontinence and fecal urgency were relieved significantly. In conclusion, for patients who develop problems with a straight PT procedure and who desire to avoid a permanent ileostomy, conversion to a PT with a lateral ileal reservoir is a valuable alternative with low risk and a high likelihood of success.

Adenomatous Polyposis Coli↗
PubMed1988

[A method for measuring the function of the organ of continence].

For preoperative assessment of anal continence we developed a simple device to measure both anal sphincter function and sensitivity of the rectal ampulla. With this instrument anorectal function was studied in 19 males and 26 females without anorectal disorders. Anal resting tone and voluntary squeeze was higher in the males than in the females. Threshold of rectal sensation and critical volume, however, were higher in females. The new device appears to work precisely enough for accurate clinical evaluation. It is less time-consuming than electromanometric methods currently in use.

Anal Canal↗
PubMed1987

[Sonographic findings in complications of cystic echinococcosis].

Apart from the difficult differential diagnosis of hydatid liver disease, diagnostic problems may increase in chronic disease because of complications. Compression or infiltration of bile ducts is the most common complication occurring in 16%. Other complications are infiltration of adjacent organs and structures, for instance the right kidney and the diaphragm, or the (often iatrogenic) rupture of hydatid cysts with intraperitoneal spread. Preoperative sonographic diagnosis is important in influencing the surgical procedure.

Adult↗
PubMed1987

[Role of Pseudomonas maltophilia and "Pseudomonas like bacteria group Va" in the etiology of Crohn disease].

In 1976, Parent and Mitchell isolated cell-wall defective bacteria of the species Pseudomonas maltophilia and Pseudomonas like bacteria group Va from resected bowel tissue of 8 consecutively operated patients with Crohn's disease. The control group, which included patients with ulcerative colitis, was negative in this respect. The isolated strains were available for our own investigations. New Zealand white rabbits were inoculated with killed bacteria to produce specific antisera. Frozen sections of affected tissue from 6 consecutively operated Crohn patients were incubated with the various antisera and investigated by indirect immunofluorescence. No positive reactions were demonstrable in repeated tests with different dilutions of antisera. Our results do not support the hypothesis that bacteria of the species Pseudomonas maltophilia and Pseudomonas like bacteria group Va are an etiologic factor in Crohn's disease.

Bacteriological Techniques↗
PubMed1987

[The acute physiology score as a stratification and prognostic criterion in patients in a surgical intensive care ward].

In order to compare different groups of intensive-care patients and therapeutic interventions a measuring system is needed reflecting the patient's pathophysiologic status with great accuracy. The APACHE-system designed by Knaus et al. (APS) meets the requirements when comparing groups of patients. This prospective study was undertaken to determine whether APS is useful to forecast survival and death of 764 individual patients of a surgical ICU. The results were compared to daily statements obtained from the head surgeon of the intensive-care department. Both the physician and APS gave true judgements in 95% of the cases. Overestimation of the operative procedures by the physician was revealed to be a major source of error in wrong statements. When a combination of APS and physician's judgement was used the forecasts were found true in 99% of the patients. The authors conclude that APS by itself is not able to give a sufficient prognosis in an individual ICU patient but is an excellent tool to assure or modify the physician's opinion.

Humans↗
PubMed1986

[Gastrointestinal amyloidosis as a differential diagnostic problem].

The diagnostic radiologist may have problems with the differential diagnosis of gastrointestinal amyloidosis combined with only uncharacteristic clinical symptoms. In the stomach upper gastrointestinal series show in most cases stenosing submucosal masses in the gastric antrum with diminished peristalsis and pliability. Sonography reveals a circular thickening of the gastric antrum wall. Only a synopsis of radiologic changes, the patients's history, laboratory tests and biopsies render a clue to the correct diagnosis. In the small bowel segmental or total intestinal dilatation with sonographically demonstrable thickening of the bowel wall and diminished motility, prolonged transit and eventually obstruction or paralytic ileus can be demonstrated. In patients with simultaneous plasmocytoma the radiologist has to take a gastrointestinal involvement by concurrent amyloidosis into account.

Aged↗