PubMed Health⌕ Search

Biomedical subjects

S Willis

Publications and source records attributed to S Willis.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of anastomotic microcirculation after low anterior rectal resection: an experimental study with different reconstruction forms in dogs.

BACKGROUND: Data on anastomotic microcirculation of coloanal anastomoses are contradictory. Therefore, it was the aim of the present study to investigate perianastomotic blood perfusion in a standardized experimental setting comparing three forms of reconstruction using laser fluorescence videography, a new method for the evaluation of microcirculation. METHODS: After a standardised rectal resection in dogs, reconstruction was performed as straight end-to-end (n = 6), side-to-end (n = 6), or J-pouch (n = 6) coloanal anastomosis. Bowel perfusion was evaluated using IC-View laser fluorescence videography. RESULTS: The perfusion index was significantly reduced in all three groups compared to the reference regions: endto-end anastomosis, median, 93% (range, 63%-136%); side-to-end-anastomosis, 65% (35%-138%); colonic-J-pouch anal anastomosis, 52% (32%-72%); p < 0.001). CONCLUSIONS: Straight coloanal anastomoses provide better anastomotic microcirculation after rectal resections than colonic-J-pouch anal anastomoses or side-to-end anastomoses. However this effect does not seem to be decisive for the prevention of anastomotic leaks.

Anastomosis, Surgical↗
PubMed2006

Defecation mechanisms after anterior resection with J-pouch-anal and side-to-end anastomosis in dogs.

BACKGROUND: Colonic J-pouch-anal anastomosis or colonic side-to-end anastomosis is the reconstruction of choice after low anterior resection. However, the mechanisms of defecation after both reconstruction forms are still speculative. METHODS: Low anterior rectal resections were performed in 12 dogs with six colonic J-pouch-anal (pouch) and six coloanal side-to-end (SE) reconstructions. Four months postoperative stool frequency, intestinal transit time, and neorectal compliance were determined by radiography and barostat. Defecation mechanisms were evaluated radiographically during expulsion of artificial stool. RESULTS: One dog with pouch reconstruction could not be evaluated due to an anastomotic leak, while the others had uncomplicated course. Spontaneous stool frequency was significantly increased with both reconstruction methods (control 2.0+/-0.9, pouch 2.7+/-1.2, SE 3.3+/-0.9 day; p<0.05). Intestinal transit time was significantly higher with pouch reconstruction due to storage of stool in the pouch and the descending colon compared to SE (control 760+/-82, pouch 592+/-97, SE 550+/-87 min; p<0.05). Compliance and functional capacity were higher in pouch than in side-to-end reconstructions (pouch 5.0+/-0.7 ml/mmHg, 124+/-23 ml; SE 2.7+/-0.3 ml/mmHg, 92+/-24 ml; p<0.05). During defecation, there were no contractions of the pouch detectable. CONCLUSIONS: The colonic J-pouch reconstruction results in better functional outcome than side-to-end coloanal anastomosis. Our results show that pouch evacuation is passive and independent from pouch motility. The functional principle of the colonic J-pouch is not its reservoir function but a delay of colonic motility.

Anal Canal↗
PubMed2006

[Current patient perceptions of the physician].

BACKGROUND: The structure and organisation of German hospitals currently are undergoing radical change forced by reforms in the German public health system. Operating procedures, efficiency assays, and management programs compete with the traditional philanthropic relationship between physician and patient. To analyse this problem by scientific means, inpatients were interviewed in standardised fashion on current expectations, ideals, and experience with that relationship. PATIENTS AND METHODS: During 4 weeks, 507 inpatients were interviewed. The structured questionnaire used consisted of nine closed multiple-choice questions. The proband sex ratio was balanced, and their age pattern represented the typical patient collective in our clinic. RESULTS AND CONCLUSION: The patient perception of physicians' roles described clear priorities. Besides a skilled expert, the patients were looking for a friend and guide through their disease, diagnosis, and therapy. The paternalistic relationship between physician and patient thus is not very antiquated. In contrast, material institutional criteria, provision of services, and hotel-like atmosphere played secondary roles.

Aged↗
PubMed2005

[Open colon surgery].

Open resection of the colon is one of the most frequent abdominal operations, which clearly indicates the great importance of colon carcinomas. The surgical aim is resection of the affected intestinal region and the according lymph drainage region. In this respect, the techniques employed are strictly standardized: right hemicolectomy for right colon carcinoma, transverse resection for right colon carcinoma, left hemicolectomy for descendent colon carcinoma, and sigmoid resection for sigmoid carcinoma. In case of benign underlying disease, the operational method depends largely on the extent to which the intestine is affected and can include anything from simple colotomy and polyp removal to colectomy for toxic megacolon. Elective colon surgery is usually primary, but in emergencies a protective stoma might be necessary. Standardized indication and operational techniques enable low perioperative mortality and complication rates that make open colon resection usually un-problematic even in very old patients.

Anastomosis, Surgical↗
PubMed2005

Subversion of the Bcl-2 life/death switch in cancer development and therapy.

The Bcl-2 protein family, which largely determines commitment to apoptosis, has central roles in tumorigenesis and chemoresistance. Its three factions of interacting proteins include the BH3-only proteins (e.g., Bim, Puma, Bad, Noxa), which transduce diverse cytotoxic signals to the mammalian pro-survival proteins (Bcl-2, Bcl-x(L), Bcl-w, Mcl-1, A-1), whereas Bax and Bak, when freed from pro-survival constraint, provoke the mitochondrial permeabilization that triggers apoptosis. We have discovered unexpected specificity in their interactions. Only Bim and Puma, which mediate multiple cytotoxic signals, engage all the pro-survival proteins. Noxa and Bad instead bind subsets and cooperate in killing, indicating that apoptosis requires neutralization of different pro-survival subsets. Furthermore, Mcl-1 and Bcl-x(L), but not Bcl-2, directly sequester Bak in healthy cells, and Bak is freed only when BH3-only proteins neutralize both its guards. BH3-only proteins such as Bim are tumor suppressors and mediate many of the cytotoxic signals from anticancer agents. Hence, compounds mimicking them may prove valuable for therapy. Indeed, the recently described ABT-737 is a promising "BH3 mimetic" of Bad. We find that, like Bad, ABT-737 kills cells efficiently only if Mcl-1 is absent or down-regulated. Thus, manipulation of apoptosis by targeting the Bcl-2 family has exciting potential for cancer treatment.

Animals↗
PubMed2004

[Reconstructive surgery after anterior resection of the rectum].

Sphincter preservation is a goal in the treatment of rectal cancer and should be considered in all patients with intact analsphincter. For tumors of the upper rectum, this is easily achieved by end-to-end decendorectostomy. Total mesorectal excision is obligatory for tumors of the mid and lower third of the rectum. Reconstruction of intestinal continuity can be achieved by colonal anastomosis, if the oncologic situation allows a sphincter-preserving procedure. Creation of a colonic J-pouch can improve functional results. This leads to a reduction of stool frequency and urgency without negative effects on continence and complication rate. The functional effects are maximal during the initial months, but are still significant up to 9 years postoperatively. The pouch should not exceed a length of 6 cm in order to prevent evacuation disorders. The transverse coloplasty pouch may allow pouch reconstruction in patients in whom this is currently impossible, but long-term follow-up is not yet available.

Anal Canal↗
PubMed2004

[Leakages after surgery of the lower gastrointestinal tract].

The incidence of anastomotic leakage in colorectal surgery is 1% to 12%. Every deviation from the normal postoperative course must raise suspicion of a leak. Diagnosis is made radiologically by rectal enema or CT. Limited leakages without clinical signs can be treated conservatively by wait-and-see. Larger anastomotic failure with intra-abdominal abscesses or peritonitis requires reanastomosis in combination with a diverting loop ileostomy or colostomy. A Hartmann procedure with open abdominal management may be indicated in severely ill patients with feculent peritonitis. In the pelvis, even large leaks may heal spontaneously when stool passage is diminished by a proximal diverting enterostomy. There is no benefit of primary loop enterostomies concerning the incidence of anastomotic leaks; however, they reduce the number of operative revisions due to anastomotic failure. Therefore they are proposed in risk patients and intraoperatively difficult anastomoses.

Abdomen↗
PubMed2004

[Fecal incontinence].

Diagnosis and management of fecal incontinence requires exact understanding of the anatomic and pathophysiologic principles involved and demands a methodical, stepwise approach. Despite the potential appeal of surgical intervention, a considerable number of patients can be helped by comparatively simple, noninvasive measures. Initial treatment should be medical, including biofeedback in combination with a bowel management program. In the presence of a severely denervated pelvic floor, physiotherapeutic techniques rarely give rise to a satisfactory and long-lasting response. Obvious external sphincter defects and patients who failed medical management are treated surgically. Many injuries of the external sphincter can be treated by direct sphincter repair. If patients with intact external sphincters are unresponsive to medical measures, descending perineum and resultant idiopathic fecal incontinence will improve by radio-frequency delivery, sacral nerve stimulation, or postanal plication. Patients with complex neurologic disorders or extensive sphincter defects or who have undergone previous unsuccessful attempts at repair of the puborectalis itself should be considered for dynamic gracilis plastic or an artificial sphincter.

Aged↗
PubMed2004

Detection of ABL kinase domain mutations with denaturing high-performance liquid chromatography.

Mutations of the ABL kinase domain (KD) are common in patients with chronic myelogenous leukemia (CML) who develop resistance to imatinib. We developed an RT-PCR-based denaturing high-performance liquid chromatography (D-HPLC) assay to detect mutations of the ABL KD. Validation experiments using mixtures of wild type and mutant amplicons showed that the D-HPLC assay could detect mutant transcripts when they represented at least 15% of the total, and was thus twice as sensitive as automated sequencing. When D-HPLC was applied to 30 cDNAs from patients with imatinib resistance that had previously been characterized for KD mutations by direct sequencing of BCR-ABL RT-PCR products, there was concordance in 97% of samples. Resequencing confirmed the original mutations in all cases. In addition, sequencing of individual clones detected a mutation in one sample that had been mutation-positive by D-HPLC but wild type by conventional sequencing. In serial samples from the same individuals, D-HPLC detected mutations as early as 260 days before hematological relapse. D-HPLC is suitable for routine clinical monitoring of CML patients for emergence of KD mutations and may be useful for optimizing therapy. Early detection of emerging mutant clones may aid in guiding decisions regarding alternative treatment options.

Adult↗
PubMed2004

[Effect of biofeedback and electrostimulation on sphincter function in fecal incontinence].

UNLABELLED: The following study reports on the effect of biofeedback and transanal electric stimulation as a conservative method in the therapy of idiopathic fecal incontinence. 22 consecutive patients in whom the diagnosis "idiopathic incontinence" was established after endoscopy, endoanal ultrasound and measurement of pudendal nerve terminal motor latency underwent combined sphincter training for 3 months. The results were evaluated prospectively by clinical classification using a modified Kelly-Holschneider-score and anal manometry before and after treatment. Combined biofeedback led to a significant increase of the continence score in 18 of 22 patients (7.7 +/- 3.8 vs. 9.3 +/- 3.0, p = 0.004). Both squeeze (77 +/- 28 mmHg vs. 92 +/- 32 mmHg, p = 0.047) and resting pressures (40 +/- 19 vs. 52 +/- 23 mmHg, p = 0.015) increased significantly during the training period. There were no significant differences in squeeze and resting asymmetry indexes, sensory and urge thresholds and maximal tolerable volumes. The prolongation of biofeedback training from 3 to 6 months in 9 patients did not change clinical or manometric results significantly. CONCLUSIONS: The combination of biofeedback training with anal electrostimulation increases anal squeeze and resting pressures, thus leading to an improvement of clinical incontinence symptoms. Therefore it should be the first choice in the therapy of idiopathic fecal incontinence. A training period of 3 months seems to be sufficient.

Adult↗
PubMed2003

Defecation mechanisms after proctocolectomy and ileal pouch--anal anastomosis in dogs.

BACKGROUND AND AIMS: The role of intrinsic pouch motility after ileal pouch-anal anastomosis (IPAA) during defecation is still speculative. MATERIALS AND METHODS: IPAA was performed in 12 dogs. Defecation mechanisms were evaluated by motility recordings during spontaneous defecation and during expulsion of an endoluminal balloon and by radiography with sequential sector-related gray scale analysis. RESULTS: Spontaneous defecations appeared without significant changes in electrical or mechanical activity of the pouch. Sequential filling of the pouch led to defecation in only seven dogs while the others did not succeed in emptying their pouch even with maximal balloon inflation. Neither strain gauge measurements nor electromyography demonstrated peristaltic contractions of the pouch during defecation while sector-related gray scale analysis revealed strong contractions of the abdominal wall during pouch emptying. CONCLUSION: Pouch emptying is independent of intrinsic pouch motility. The ileoanal pouch acts as a functionally passive reservoir, and its evacuation is initiated by a rise of the intra-abdominal pressure.

Anal Canal↗
PubMed2003

Repair of intercostal pulmonary herniation.

Intercostal pulmonary herniation occurring years after blunt thoracic trauma is a rare phenomenon. We report on the case of a 66-year-old patient who developed a pulmonary herniation 2 years after a seat-belt injury. Thoracotomy was performed, and the thoracic wall defect was closed with approximating periostal absorbable sutures. The postoperative course was uneventful. Different surgical approaches and the use of prosthetic patches are discussed. Periostal fixation of the adjacent ribs with absorbable sutures is usually sufficient for herniation repair. In cases in which prosthetic meshes are needed, the application of PTFE might produce the best results with the least complications.

Aged↗
PubMed2003

Preliminary reference levels in interventional cardiology.

This article describes the European DIMOND approach to defining reference levels (RLs) for radiation doses delivered to patients during two types of invasive cardiology procedures, namely coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA). Representative centres of six European countries recorded patients' doses in terms of dose-area product (DAP), fluoroscopy time and number of radiographic exposures, using X-ray equipment that has been subject to constancy testing. In addition, a DAP trigger level for cardiac procedures which should alert the operator to possible skin injury, was set to 300 Gyxcm2. The estimation of maximum skin dose was recommended in the event that a DAP trigger level was likely to be exceeded. The proposed RLs for CA and PTCA were for DAP 45 Gyxcm2 and 75 Gyxcm2, for fluoroscopy time 7.5 min and 17 min and for number of frames 1250 and 1300, respectively. The proposed RLs should be considered as a first approach to help in the optimisation of these procedures. More studies are required to establish certain "tolerances" from the proposed levels taking into account the complexity of the procedure and the patient's size.

Angioplasty, Balloon, Coronary↗
PubMed2003

[Defecation problems following radical perineal prostatectomy. A prospective study].

PURPOSE: The true incidence of bowel symptoms prior to radical prostatectomy, as evaluated by a differentiated questionnaire, is unknown. We therefore performed a prospective study on patients who were scheduled for radical perineal prostatectomy. MATERIAL AND METHODS: A total of 67 patients with cT1-cT3, N0, M0 prostate cancer underwent an extrafascial, radical, perineal prostatectomy. The patients received a questionnaire prior to surgery as well as 6 months and 12 months after surgery. This took into account demographic data, stool symptoms (Kelly questionnaire) and questions concerning bladder function (ICS male continence questionnaire). The questionnaires were evaluated by three of the authors not involved in patient care. RESULTS: The mean age of the patients was 64 years. The PSA range was 0.9-55.6 ng/ml (mean 12.7 ng/ml). There were 47 pT2, 19 pT3 and a single pT4 tumour. A total of 59 patients had a Gleason score of 6 or less. Positive surgical margins were present in four patients. The 12 months follow-up questionnaire could be evaluated for 82% of the patients (n=55). In addition, 46 patients answered the questionnaire at 6 months post-surgery. Three or more problems in relation to bowel movements were reported preoperatively by 21% of the patients. Straining with bowel emptying was the symptom which was indicated most often. Stool smearing was reported by 13% of patients at least once or twice monthly. In addition, 6% of patients reported that they had difficulties in differentiating soft stool from gas. After 1 year, seven (13%) of the patients reported stool smearing which was not present prior to surgery. Six of these patients observed this problems only once or twice a month. Only one patient had stool smearing once a week. Two patients reported urgency, two had a decreased warning time and one reported decreased sensibility. Two patients used protective pads. The most frequent symptom reported postoperatively was straining with bowel emptying (24% preoperatively and 16% postoperatively). CONCLUSION: It is evident that men scheduled for radical prostatectomy already have significant stool problems preoperatively. Newly developed, postoperative stool smearing on a daily basis occurred extremely seldom. They same is true for the discrimination between soft stool and gas. From our point of view, it is important to use the extrasphincteric approach to the prostate described by Young. Furthermore, the pubo-anal sling should be preserved.

Constipation↗
PubMed2003

[Assisted death in daily surgical practice--an interdisciplinary discussion with examples].

New laws for assisted patient death in The Netherlands and Belgium have resulted in animated discussion about the permissibility of the practice in Germany. Physicians here are being confronted more and more by patients and their relatives with the wish for assisted death. Polls confirm that the majority of this population supports active death assistance, whereas doctors reject it. At a symposium in October 2002 (Clinically Assisted Death and Human Dignity-A Dutch-German Dialogue), case studies illustrating this question were presented. The present study compiles viewpoints of physicians, ethicists, theologians, jurist, politicians, and journalists.

Adult↗
PubMed2003

[Functional results and quality of life after proctocolectomy and ileal J-pouch-anal anastomosis for ulcerative colitis].

BACKGROUND: Ileal pouch-anal anastomosis is the surgical standard in the therapy of ulcerative colitis. It was the aim of the present study to evaluate functional long-term results and correlate them with quality of life. PATIENTS AND METHODS: 37 patients with a follow-up of more than 5 years were included. Functional results and quality of life were assessed by standardised questionnaires (modified Kelly-Hohlschneider-Score, EORTC QLQ-C30). RESULTS: 24 of 37 patients could be evaluated. Median follow-up was 8 (5-13) years. Postoperative stool- frequency was 5.5 +/- 1.7/d. When compared with the preoperative situation, patients suffered less from urgency. Stool-frequency and -consistency, soiling and sensibility remained unchanged. 83 % of patients had a subjective increase of life quality with the ileoanal pouch. The quality of life index was almost normal with 83 (28-100) %. Patients with postoperative complications had a significant decrease of life quality when compared to patients with uneventful course. There was no statistically significant correlation of life quality with age, gender or stool continence. CONCLUSIONS: Ileal pouch-anal anastomosis leads to a long-term increase of stool frequency with partially impaired stool continence. Patients with uneventful course have a significantly better life quality.

Adolescent↗