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Biomedical subjects

S M Freys

Publications and source records attributed to S M Freys.

At least 19 recordsLinked to original sources
PubMed1999

[Functional diagnosis of pelvic floor insufficiency--consequences for surgery].

Functional tests allow for the qualification and quantification of underlying function defects in the diagnosis of pelvic floor incompetence. However, the results of these instrumental investigations alone do not suffice for a therapeutic decision. The decision for a surgical therapy should therefore always be based on the clinical presentation, the extent of subjective impairment, and the degree of the causative pathophysiologic defect detected in the function tests.

Fecal Incontinence↗
PubMed1998

Inter- and intraindividual reproducibility of anorectal manometry.

BACKGROUND: This study investigates the inter- and intraindividual variability of normal values and, thus, the reproducibility of anorectal manometry. MATERIALS AND METHODS: Following a standardized protocol, three anorectal manometries were performed 4 h apart on 2 days of investigation, with an interval of 4 weeks, in ten healthy volunteers. Measured parameters in all 60 manometries were: sphincter length (SL), resting pressure (RP), maximum squeeze pressure (MSP), relaxation of the internal anal sphincter (RIAS), and rectal compliance (RC). Interindividual variability was expressed as standard deviation from calculated mean values and intraindividual variability was tested with Wilcoxon's test for tied samples and Spearman's rank correlation test. RESULTS: A large interindividual variability was found for all measured parameters, except for SL, reflecting the extensive absolute range of measured values. Median intraindividual variability among the six individual measurements and between both measurement days revealed that MSP, RIAS and RC are parameters which were not reproducible in this volunteer study. A significant correlation between the results of the repetitive measurements and, thus, a good reproducibility was only found for the parameters SL and RP. CONCLUSIONS: Anorectal manometry has only limited diagnostic value; although rather exact quantifications of individual parameters can be achieved, the impact of these measurements should be regarded rather critically, since only SL and RP appeared to be reproducible parameters.

Adult↗
PubMed1998

Application of the new classification for cancer of the cardia.

BACKGROUND: Cancer of the cardia is now topographically classified into three types: type I, with the tumor center in the distal esophagus treated with subtotal esophagectomy; type II, arising at the gastroesophageal junction and treated with distal esophagectomy and either proximal or total gastrectomy; and type III, subcardial cancer treated with extended total gastrectomy. Our objective was to review the new classifications and compare the outcomes in patients grouped and treated according to these classifications. METHODS: Seventy-four patients with cancer of the cardia--15 with type I, 30 with type II, and 29 with type III cancer--underwent surgical resection at our institution between 1992 and 1997. Postoperative complications, UICC stages, and survival (Kaplan-Meier) were compared. RESULTS: The majority of patients with type I (73%) or type II (53%) cancer had stage I or II tumors, but only 27% of patients with type III cancer had this tumor stage (P < .05). Overall 30-day mortality was 4% and morbidity was 31%. Curative resections were performed in 73% (54 of 74) of the patients with 3-year survival rates of 72% (type I), 68% (type II), and 61% (type III). CONCLUSION: The recommended therapy for the different types of cancer of the cardia results in acceptable morbidity, mortality, and survival rates.

Adenocarcinoma↗
PubMed1998

[Laparoscopic anti-reflux surgery--report of experiences from Germany].

This is a report on a questionnaire in Germany reflecting the activity in antireflux surgery, both in open and laparoscopic modifications in the time period of 1990 through 1995. It serves as an overview of the acceptance of diagnostic workup, indication, applied techniques, and different antireflux procedures. In a total of 104 representative hospitals, 2,036 patients were operated during this time. Almost 80% of the hospitals provide antireflux surgery in the open technique and only 1/3 of the hospitals have experience in the laparoscopic technique. There is a total rise in antireflux surgery during the last 5 years, since the number of laparoscopic antireflux operations rises constantly with a total amount of open operations of about 250 cases per year. In open surgery the most favourite technique is the Nissen-Rossetti procedure, while in laparoscopic technique the choice for the original Nissen, the Nissen-Rossetti, or the floppy Nissen technique is divided in almost equal parts.

Cross-Sectional Studies↗
PubMed1997

Tailored augmentation of the lower esophageal sphincter in experimental antireflux operations.

BACKGROUND: Modern upper GI function studies allow for the detection of several pathophysiological factors that contribute to gastroesophageal reflux disease. The information obtained can lead to therapeutic consequences in patients with an indication for a surgical intervention, i.e., an individualized choice of antireflux procedure according to the existing pathophysiologic defect. METHODS: In an experimental study on mini-pigs the mechanical effect of four standardized antireflux operations (anterior and posterior 180 degrees hemifundoplication, Nissen-DeMeester and Nissen-Rossetti 360 degrees fundoplication) on the lower esophageal sphincter (LES) was investigated. It was the aim of the study to objectively determine the extent of changes in pressure and length parameters at the LES according to the performed antireflux procedure. RESULTS: It could be demonstrated that different degrees of fundic wrap formation lead to a proportional mechanical effect at the LES according to the size of this wrap. CONCLUSION: Choosing a distinct type of fundoplication will allow for a tailored augmentation of the LES according to the individual functional defect.

Animals↗
PubMed1997

[Laparoscopic interventions in gastroesophageal reflux--a cost-benefit analysis].

On the basis of a cost analysis of conservative and surgical therapy of gastroesophageal reflux disease in 70 patients health economic aspects are discussed. In a prospective documented series of reflux patients a retrolective analysis of medication cost and duration of conservative therapy is performed. In addition, the costs for surgical therapy including preoperative diagnostic workup, cost during hospitalization as well as costs for complications with necessary additional treatment and readmissions are assessed. For the conservative treatment of 70 reflux patients a total of more than DM < 700,000 had to be spent during preoperative 5 years. A major part of this sum was spent for patients who needed to increase the initial 20 mg dosage of Omeprazol within 5 years. A mean of approximately DM 2,000 per patient was spent for conservative treatment. Surgical treatment without complications was calculated with DM 5,425 per case. However, in 7 patients complications occurred causing prolonged or even rehospitalization with necessary further treatment summing up to about DM 486,000 for surgical therapy in 70 patients including complications. Cost relevant factors are therefore in conservative treatment patients who need increasing dosages, while, in surgical treatment, the cost relevant patients are those with complications and necessary additional treatment.

Adolescent↗
PubMed1997

[Olecranon and pre-patellar bursitis].

Olecranon and prepatellar bursitis have a prevalence of 3 in 1000 patients; the predominant etiology is a traumatic lesion with or without inoculation of infectious material, mainly during professional or leisure activities. Separation into septic and non-septic bursitis is possible in most cases according to clinical parameters and characteristics of the contents of the affected bursa. The therapy of acute and chronic bursitis is guided mainly by the nature of the aspirate retrieved from the bursa: a serous content justifies conservative treatment with compression, immobilization, antiphlogistic medication, and (in selected cases) the instillation of corticosteroids; a purulent aspirate necessitates bursotomy with incision and drainage, or bursectomy. Only in selected cases is a conservative trial with antibiotics, immobilization, and antiphlogistic medications justified.

Bursitis↗
PubMed1997

[How expensive is treatment of reflux disease?].

In a prospective documented series of reflux patients, a retroelective analysis of medication cost and duration of conservative therapy as well as the costs for surgical therapy including preoperative diagnostic workup, cost during hospitalization, and costs for complications with necessary additional treatment and readmissions is assessed. Cost-relevant factors are in conservative treatment cost-relevant factors are those patients who need increasing dosages, while in surgical treatment the cost-relevant patients are those with complications who need additional treatment.

Anti-Ulcer Agents↗
PubMed1996

The mode of Roux-en-Y reconstruction affects motility in the efferent limb.

OBJECTIVES: To compare motility of a Roux-en-Y esophagojejunostomy after total gastrectomy with normal jejunal motility and to determine the effect on motility of the incorporation of a pouch in the reconstruction. DESIGN: Jejunal motility in normal subjects was compared with jejunal motility in the Roux-en-Y reconstruction with and without a Hunt-Lawrence pouch. SETTING: The case were collected during a 4-year period at a university hospital. The mean time from resection to study was 14 months (range, 4 to 49 months). PATIENTS: Seven control patients were compared with 10 patients with a Roux-en-Y reconstruction and 17 with a Roux-en-Y and Hunt-Lawrence pouch. OUTCOME MEASURE: The fasting-state motility of the jejunum used for reconstruction was measured by a water-perfused manometric system for 2 to 4 hours with the subject in the supine position. RESULTS: Compared with normal subjects, patients with a Roux-en-Y esophagojejunostomy without a pouch had an increased number of phases of the interdigestive motor complex per hour (P < .05). The phases were of shorter duration with a random sequence and increased total time spent in the quiescent phase 1 (P < .05). In patients with a pouch, no differences were detected between the motility in the pouch and the efferent limb. Compared with those without a pouch, there were significantly fewer orthograde interdigestive motor complex phase 3 fronts and more total time spent in phase 1 (P < .05). CONCLUSIONS: Construction of a gastric substitute from jejunum leads to substantial motility changes. The addition of a pouch decreases the overall activity, which may contribute to the storage function of the pouch.

Adult↗
PubMed1996

Fiberoptic technique for 24-hour bile reflux monitoring. Standards and normal values for gastric monitoring.

Physiologic bile reflux was assessed in 27 in vivo test with healthy volunteers to define a standardized protocol and normal values for 24-hour enterogastric bile reflux monitoring (protocol with supine, upright, and meal phases and a free diet avoiding alcohol, smoking, and coffee, evaluation with different thresholds of absorbance units: 0.14, 0.25). In vitro tests with bile-sodium solutions demonstrated a linear dependence of absorbance for bilirubin up to 600 mumol/liter (range of the fiberoptic device: 0.0-1.0). Fluids and food might interfere with absorbances below 0.25 (exception: coffee). In vivo bile often remains in the stomach for more than 1 hr; these events were defined as reflux episodes. The upper limits for physiologic bile reflux are a percentage of total time of bile reflux of 28.2% and an average absorbance during a reflux episode of 0.62 (95th percentile with threshold 0.25). Comparing bile with pH monitoring (absorbance > 0.25 and/or pH > 4), an increase of bilirubin was found most frequently with constant pH (45%) or an increase of pH with constant bilirubin (36%). The hypothesis was drawn that bile and duodenal or pancreatic secretions may separately contribute to duodenogastric reflux.

Adult↗
PubMed1996

[Differential concept on use of laparoscopic anti-reflux operations].

The introduction of laparoscopic technique in antireflux surgery has created hope for an improvement in patient outcome. Initial experience with minimally invasive procedures show that the application in antireflux surgery depends more on a differentiated indication for operation and an operative procedure designed to remove or compensate the underlying pathophysiologic functional defect. The method of access is of lesser priority. The promising results of this series may encourage continuation of the demonstrated protocol and operative technique.

Adult↗
PubMed1996

[Anorectal pull-through and vector volume manometry].

Anorectal manometry has been developed from an object of clinic oriented scientific interest to an established tool within the spectrum of proctologic diagnostics. At present it represents the only objective diagnostic method with regards to continence disorders; it is routinely applied in the evaluation of constipation, of incontinence, of pre- and postoperative conditions in diseases of the anorectum as well as in the indication and therapeutic control investigations during biofeedback training of the anal sphincter. The new technique of determination of the anal sphincter pressure vector volume allows for the most sensitive functional separation of patients with different degrees of continence; this method delivers a 3-dimensional graphic imaging of the sphincter pressure profile, thus allowing for an objective visualisation of the present mechanic defect and an aid in planning a surgical correction.

Anal Canal↗
PubMed1995

Teaching upper gastrointestinal endoscopy: the pig stomach.

An easily applicable teaching and training technique for flexible endoscopy in the upper gastrointestinal tract is presented. Using a fresh, flushed-out pig stomach with adherent esophagus and duodenum, the trainee endoscopist can practice all the essential endoscopic diagnostic and interventional techniques. The teaching model proposed requires little preparation, represents a cheap and easy technique with widespread applicability, offers a high degree of learning efficiency, and is appropriate for specialized teaching courses.

Animals↗
PubMed1994

Laparoscopic adhesiolysis.

The aim of this study was the detection of criteria that support the indication for laparoscopic adhesiolysis in patients presenting with unspecific symptoms. A prospective analysis investigates the value of laparoscopic adhesiolysis in patients with chronic abdominal pain after exclusion of other pathologic findings; 58 consecutive patients were followed after laparoscopic adhesiolysis. Endpoints of investigation were extent of adhesions, complications, postoperative hospitalization, and postoperative quality of life. A comparison was drawn to patients following laparoscopic cholecystectomy, laparoscopic cholecystectomy plus adhesiolysis, and conventional cholecystectomy. The results showed that major complications occurred in 10% of cases. In 45% of patients we found a complete remission, in 35% a substantial improvement, and in 20% a persistence of complaints. In a correlation between the preoperative complaints and the extent of adhesions we found small adhesions to cause recurrent abdominal pain without other symptoms while large adhesions produce recurrent abdominal pain in combination with symptoms indicative of intermittent bowel obstruction. Finally, the results of this study indicate a certain "ideal constellation" for an enduring successful adhesiolysis per laparoscopy: it is the subjective complaint of recurrent abdominal pain with a localized and reproducible punctum maximum in combination with a circumscribed area of adhesions at that site.

Abdominal Pain↗
PubMed1994

Motility in the Hunt-Lawrence pouch after total gastrectomy.

PURPOSE: The aim of this study was to evaluate motility patterns of the Hunt-Lawrence pouch and the jejunal limb of patients reconstructed with a pouch after total gastrectomy, and to compare the findings in symptomatic patients to those without symptoms after the operation. PATIENTS AND METHODS: Thirty-three patients who had undergone post-gastrectomy pouch reconstruction were studied using a water-perfused motility system. In 21, the pouch was connected by a Roux-en-Y, and, in 12, by a jejunal interposition. Twenty-eight patients were asymptomatic, including 17 connected by a Roux-en-Y and 11 by a jejunal interposition. Five patients were by a jejunal interposition. Five patients were symptomatic, including 4 connected by Roux-en-Y Y and 1 by jejunal interposition. A control group consisted of 5 healthy volunteers who had not undergone operation. RESULTS: The motility phases in the pouch and jejunal limb of asymptomatic patients were of shorter duration than those of controls, and they followed a random sequence instead of a normal progression from phase I to II to III. Motility features were similar in the pouch and the jejunal limb. Orthograde propagation of phase III-like activity was reduced and may contribute to the pouch storage function. Four of the 5 symptomatic patients showed highly abnormal motility with hypomotile or obstructive patterns. The technique of connecting the pouch--jejunal interposition of Roux-en-Y--did not affect the motility findings. CONCLUSIONS: The altered motility occurs after a Hunt-Lawrence pouch reconstruction in asymptomatic patients. Symptoms after gastrectomy are associated with further disturbed motility that can be differentiated from the motility changes in asymptomatic patients.

Adult↗
PubMed1994

[Techniques of follow-up examination of the ileoanal and colo-anal pouch].

For the assessment of ileoanal and coloanal pouches different diagnostic tests should be applied. Apart from case history and rectal digital examination the most important methods comprise a radiologic evaluation of the pouch and its afferent loop as well as anorectal manometry for the assessment of pouch motility and sphincter function. Increasingly transanal endosonography is being used for the precise examination of size, volume, and shape of ileoanal and coloanal pouches. The afferent loop is also easily accessible to endosonography, e.g. for evaluation of bowel wall morphology and function. Furthermore, in cases of coloanal pouches following an oncologic lower anterior resection, endosonography is used in follow-up examinations for the detection of local tumor recurrence.

Adenomatous Polyposis Coli↗
PubMed1994

[Laparoscopic interventions in previously operated patients].

This prospective study investigates the technical feasibility and the potential advantage of laparoscopic operative techniques in patients following previous surgery. Data were obtained from a group of patients following previous surgery who underwent laparoscopic cholecystectomy, explorative laparoscopy, laparoscopic adhesiolysis, or laparoscopic procedures on the intestinal tract; all of these patients presented intraabdominal adhesions leading to a change of the originally intended operative procedure. 240 patients who underwent laparoscopic cholecystectomy without previous surgery or with previous surgery but without relevant adhesions represented the control group. Endpoints of investigation were duration of operation, post-operative hospitalization, intra- and postoperative complications, and postoperative quality of life. A total of 370 patients was followed after laparoscopic procedures. With an equal distribution of complications in both groups a higher percentage of calculated and emergency conversions was found in the group of patients following previous surgery; these conversions did not lead to a larger ratio of complications. The patients' postoperative quality of life, recorded by means of a complaint score, was equal in both groups. These results show that "previous abdominal surgery" does not represent a contraindication for laparoscopic surgery and that patients following previous surgery will profit from laparoscopic operations to the same extent as already proven for patients undergoing laparoscopic procedures without previous surgery.

Abdomen↗