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Biomedical subjects

W Feil

Publications and source records attributed to W Feil.

At least 19 recordsLinked to original sources
PubMed1992

[2 cases of life threatening gastrointestinal hemorrhage from Meckel's diverticulum].

Meckel's diverticulum is one of the commonest congenital anomalies of the gastrointestinal tract. Two cases requiring emergency laparotomy due to massive gastrointestinal bleeding are presented. Only at laparotomy the correct diagnosis was established. In the first case a segment of small bowel was resected and diverticulectomy was performed in the second case. Both patients are free of complaints now at 2 and 3 years of follow-up respectively. The genesis of diverticular bleeding, the difficulties of the preoperative diagnosis of the complicated diverticulum and the uncertain indication for operation in cases of uncomplicated diverticulum are discussed and the literature is reviewed.

Adolescent↗
PubMed1992

MIPSY: real-time morphometry to quantify the time course of rapid epithelial restitution.

The gastrointestinal mucosa has the ability to repair itself rapidly following superficial mucosal injury by rapid epithelial restitution. The mechanism consists of cell migration and does not involve mitosis. This study reports the mechanisms of rapid epithelial restitution in the rabbit colon in vivo and in the human colon in vitro, describes a new computerized real-time morphometry system to investigate the time course of restitution and presents a new method to calculate the migration speed of epithelia during the repair process. Superficial mucosal damage to the rabbit colon in vivo was produced by luminal exposure to 100 mM HCl for 5 min (80% of mucosal surface), a comparable injury in the human colon in vitro was obtained by luminal exposure to 10 mM HCl for 10 min (96% of mucosal surface). After detachment of the damaged tissue the intact epithelial cells in the vicinity of the necrosis extended pseudopodia and migrated over the denuded basal lamina. The morphological appearance of rapid epithelial restitution was the same in the rabbit and the human, only the time course was postponed in the human. The time course of rapid restitution was assessed by a newly developed computerized morphometry system (MIPSY). When tissues were examined after various time points following acid damage, 61% of the mucosa were damaged in the rabbit after 1 h, 10% after 2 hs and 20% after 5 hs. In the human colon 85% of the mucosal surface were damaged after 2 hs and 20% 5 hs after the end of acid exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[The percutaneous catheter drainage of pancreatic pseudocysts].

The results of CT/US-guided percutaneous drainage in 35 patients with pancreatic pseudocysts are reported. 27 patients recovered without surgery and no further treatment was required. 8 patients required a subsequent surgery due to recurrence. The role of CT/US-guided percutaneous drainage in pancreatic pseudocysts as well as an analysis of the technical aspects associated with a successful procedure are discussed. Although US may be used, we believe CT is safer and allows more precise localisation and guidance in the treatment of pseudocysts.

Adult↗
PubMed1991

Factors influencing the restitution of the duodenal and colonic mucosa after damage.

Rapid epithelial restitution is an important protective mechanism which enables the gastrointestinal mucosa to reestablish epithelial integrity following superficial injury within hours. In this study we examined the influence of an acidic luminal pH, removal of the necrotic layer, nutrient bicarbonate, calcium and sodium desoxycholate (Na-DOC) on restitution in the rabbit duodenum in vitro and the role of Na-DOC and calcium for rapid restitution of the human colon in vitro. Transmucosal potential difference (PD), short-circuit current (lsc) were measured and resistance against passive ion flux (R) was calculated. Electrophysiological changes paralleled morphological injury but did not necessarily reflect restitution in all experiments. The extent of mucosal injury was assessed by computerized real-time morphometry. 5 hrs after luminal exposure to 10 mH HCl for 10 min residual damage (RD) was 14% in the duodenum. Luminal pH of 3.0 (RD of 30%), removal of necrotic layer at acidic luminal pH (RD of 66%), absence of bicarbonate from the serosal solution (RD of 35% at neutral luminal pH; RD of 96% at acidic luminal pH) and removal of calcium from the serosal solution (RD of 58%) impaired restitution in the duodenum. Continuous postinjury luminal Na-DOC exposure did not influence restitution in the duodenum (RD of 19%). 5 hrs after luminal exposure to 0.5 mM Na-DOC for 10 min RD was 26% in the human colon. Continuous postinjury luminal Na-DOC exposure (RD of 51%) and removal of calcium from the nutrient solution (RD of 65%) impaired restitution in the human colon. Thus we conclude that restitution of the rabbit duodenum in vitro requires a necrotic layer and bicarbonate flux to withstand acidic luminal pH, while restitution is not affected by Na-DOC. In the human colon Na-DOC inhibits restitution. Both the duodenum and colon require calcium for rapid restitution.

Animals↗
PubMed1990

[Rectal cancer: prognostically relevant factors for the development of local recurrence following radical anterior resection].

The study was designed to detect criteria which influence the incidence of local recurrence after radical anterior resection for rectal cancer. Local recurrence developed in 18 patients (20%) out of 90. All patients entered a prospective clinical study for the detection of local recurrence (mean observation time: 50 months). The following criteria were evaluated retrospectively: age, sex, staging, grading, gross appearance of the tumour, lymphatic reaction, invasion of lymph and blood vessels, perineural invasion, mucus production of the tumour and width of the distal margin of clearance (measurement in cm in the specimen immediately after resection). Kaplan-Meier survival functions estimated the probability of staying free of local recurrence depending on the various criteria. Statistical significance was calculated using the tests of Breslow and Mantel. The incidence of local recurrence (%) depended on Dukes stage (A: 7%, B: 17%, C: 40%; p less than or equal to 0.03), grading (well differentiated: 5%, average: 20%, poorly differentiated: 55%; p less than or equal to 0.02), gross appearance (protuberant: 15%, infiltrating: 47%; p less than or equal to 0.006), lymphatic stroma reaction (yes: 10%, no: 45%; p less than or equal to 0.006), invasion of veins (yes: 75%, no: 20%; p less than or equal to 0.002), perineural invasion (yes: 52%, no: 17%; p less than or equal to 0.001) and the margin of clearance (less than 1 cm: 52%, 1-3 cm: 10%, greater than 3 cm: 15%; p less than or equal to 0.02 Mantel, p less than or equal to 0.05 Breslow between less than 1 cm vs. 1-3 cm and greater than 3 cm, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Intracellular pH regulation in human SW-620 colon cancer cells].

Intracellular pH (pHi) regulation is essential for basic functioning of the cell and activation of pHi regulatory mechanisms appears to be involved in the initial stage of cell division. Little is known about pHi regulation in human colonic carcinoma cells. We investigated SW-620 (CCL 227) cells, a cell-line derived from a human colonic adenocarcinoma. pHi changes were recorded by computer-assisted spectrofluorimetric monitoring of the pH-sensitive, fluorescent dye BCECF (2',7'-bis(carboxyethyl)- 5(6)carboxyfluorescein). Resting pHi in HEPES (N-2-hydroxyethylpiperazine-N'-2-ethanesulfonic acid) buffered solution was 7.53 +/- 0.01. Intracellular acidification after an ammonium prepulse produced a pHi decline of 0.5 units and pHi returned to normal value in NaCl Ringer's. Both 1 mM amiloride and Na-free solution completely inhibited recovery for 8 minutes. This inhibition was reversible in NaCl Ringer's. Na-free solution led to a pHi decrease to 7.39 +/- 0.04 after 16 min, pHi was also lowered by 8 minute incubation of cells with 1 mM amiloride (7.40 +/- 0.02). In HCO3/CO2-buffered solution resting pHi was 7.42 +/- 0.01 (n = 35). Recovery from an acute acid load, induced by NH4 prepulse or switching from HEPES- to bicarbonate-buffered solution, was Na dependent, Cl independent, reversible and only partially blocked by 1 mM amiloride - pHi slowly recovered from 6.83 +/- 0.03 to 7.00 +/- 0.06 in 8 minutes. In the presence of amiloride and 200 microns H2DIDS (dihydro-4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid) pHi recovery was completely inhibited for 8 minutes. In Na-free solution pHi decreased from 7.44 +/- 0.04 to 7.29 +/- 0.03 within 8 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1990

Mechanisms of stress ulceration and implications for treatment.

The incidence of stress ulceration and its complications has decreased over the last decade significantly. The reason for this development is the better understanding of the protective mechanism of stomach and duodenum as well as the prophylactic treatment. This can be achieved by antacids, H2-blockers, and sucralfate, whereas prostaglandins are not effective.

Antacids↗
PubMed1989

[Familial colon cancer].

5 families with autosomal dominant inherited colonic cancer were analyzed with reference to the characteristics of familial colonic cancer: 45% out of 54 family members had colorectal carcinomas, with a mean of 4.5 affected members per family. The mean age on diagnosis of colonic cancer was 43.9 years. 50% of the colorectal carcinomas were located in the right colon; 11 out of 14 carcinomas were Dukes C, with a predominance of poorly differentiated adenocarcinomas and mucin-producing cancers. 22% had synchronous cancers and 13% developed metachronous cancers. Cancer at another location was found in 8.7% of cases. Prospective screening of relatives (siblings, children) revealed a colonic neoplasm in 3 out of 6 asymptomatic subjects. The typical characteristics of familial colonic cancers were demonstrable in our patients. The elucidation of an exact family history in all patients with colorectal carcinoma and a strategy of meticulous surveillance are absolutely necessary for the diagnosis and management of this inherited trait.

Adenocarcinoma↗
PubMed1989

[Minor surgery].

The main task of the general practitioner is not only the early diagnosis of oncologic diseases and the follow-up of these patients, but also the emergency treatment of acute disorders as well as outpatient surgery. This summary overlooks the surgical facilities of the general practitioner to perform urgent and elective outpatient surgery. In addition, the focus is on the management of acute disorders and complications.

Ambulatory Surgical Procedures↗
PubMed1989

Rapid epithelial restitution of human and rabbit colonic mucosa.

Rapid epithelial restitution is now considered one of the primary defense mechanisms of the stomach and duodenum. Because there is currently no evidence as to whether restitution occurs in human tissue, this study examined human and rabbit colonic mucosa after superficial injury and monitored the potential difference, alkaline flux, and speed and mechanisms of mucosal restitution as observed with light and electron microscopy. Luminal exposure of the in vivo rabbit colon to 100 mM HCl for 5 min or the in vitro human colon to 10 mM HCl for 10 min caused superficial mucosal injury to 76% of the epithelial surface in the rabbit and 95% in the human. The necrotic epithelial cells detached in sheets from the intact basal lamina and formed a protective mucoid layer. Morphologic evidence of restitution occurred within 15 min after injury in the rabbit and 30 min in the human, as viable nongoblet cells projected lamellipodia and migrated over the denuded basal lamina at a speed of approximately 2 microns/min. One hour after damage 61% of the mucosal surface was still damaged in the rabbit, and 86% of the human mucosal surface was damaged after 2 h. In the following 60 min restitution progressed rapidly, so that only 10% of the surface remained unrepaired in the rabbit after 2 h and 19% in the human after 3 h. Small areas with deeper injury did not repair until 5 h after damage. The potential difference dropped after mucosal injury and did not recover despite morphologic repair. Rapid epithelial restitution is considered to be a basic defense mechanism of the gastrointestinal mucosa that is obviously not necessarily related to the presence of an acidic environment in the stomach or duodenum.

Animals↗
PubMed1989

Importance of an alkaline microenvironment for rapid restitution of the rabbit duodenal mucosa in vitro.

Rapid epithelial restitution after superficial damage of the gastroduodenal mucosa consists of the migration of remaining intact epithelial cells beneath a necrotic layer of mucus and shed cells. Complete reepithelialization occurs within 60 min (rat stomach) to 7 h (rabbit duodenum) and does not involve cell division. The present study investigated rapid restitution of the acid-damaged rabbit duodenal mucosa in vitro under various conditions. Alkaline flux and transmucosal potential difference were measured simultaneously, and computerized morphometry was performed. Rapid restitution was nearly completed 5 h after damage at neutral luminal pH, but it was retarded when the luminal pH (pHL) was kept at 3. Removal of the necrotic layer did not impair restitution at neutral luminal pH but caused delay at acidic pH (pHL = 3.0). Removal of nutrient bicarbonate slightly delayed restitution at pHL = 7.4 and caused complete inhibition at pHL = 3.0. Alkaline secretion was usually stable but was nearly totally abolished after removal of nutrient bicarbonate. The potential difference decreased after acid damage and showed a tendency to recover in parallel with mucosal restitution. This gradual recovery correlated directly with morphometry. The authors assume that rapid restitution of the duodenal mucosa at an acidic luminal pH depends on the presence of a protective necrotic layer and sufficient alkaline secretion to maintain an optimal environment adjacent to the mucosa. Disturbance of this alkaline microenvironment could be important for the development and healing of duodenal ulcer.

Alkalies↗
PubMed1989

Role of acid base balance and mucosal blood flow in alkaline secretion of rabbit duodenum.

Alkaline secretion of the duodenal mucosa is thought to be an important protective mechanism against luminal acid. This study was designed to investigate the role of acid base balance and mucosal blood flow for duodenal alkaline secretion in an in vivo preparation. Segments of proximal duodenum of anaesthetised New Zealand white rabbits were canulated and perfused in situ. Alkaline secretion (pH-stat method), mucosal blood flow, arterial pO2, pCO2 and HCO-3 were measured. We have found that metabolic alkalosis and glucagon led to a significant increase in alkaline secretion, while metabolic acidosis and vasopressin significantly reduced it. Mucosal blood flow was significantly changed under glucagon and vasopressin.

Acid-Base Equilibrium↗
PubMed1989

Role of passive HCO3(-)-diffusion in duodenal acid-stimulated alkaline secretion.

We investigated acid-stimulated alkaline secretion (AS) under different luminal acid concentrations and its relation to mucosal damage on isolated proximal rabbit duodenal mucosa. Luminal HCl caused an increase of AS depending on their concentration, and it was not specific for acid, but occurs also with luminal ethanol. Histology showed [H+]-dependent mucosal damage ranging from villus tip lesions to deep mucosal injury. Ouabain- and/or anoxia-sensitive (active) AS constituted 80% and 100% respectively of basal AS. After exposure to various luminal acid concentrations passive diffusion (sensitive only to removal of nutrient HCO3-) was solely responsible for the rise in AS. We conclude that in the in vitro rabbit duodenum passive diffusion of HCO3- associated with increasing mucosal damage is the major component of the rise in AS.

Animals↗
PubMed1988

[Repair of the duodenal mucosa following acid damage. A protective mechanism as an approach to new therapeutic principles?].

Epithelial repair after luminal acid exposure was studied in the rabbit duodenum in vivo, HCl (200 mM for 30 min) caused uniform damage of the mucosa confined to the villi, 50% of the total villus height was affected by the acid-induced lesion in the proximal, and 70% in the distal duodenum. After demarcation and detachment of the necrotic tissue the defect was bridged by the remaining viable epithelial cells underneath a layer of mucus and necrotic debris (= necrotic layer). Mucosal repair resulted in a reduction of villus height by 62% in the proximal, and 77% in the distal duodenum. This process of mucosal repair progressed continuously, so that 9 hours after acid damage only 33% of villi in the proximal, and 41% in the distal duodenum were not yet fully restored, irrespective of luminal pH(pHL = 7 or pHL = 3). The difference between proximal and distal duodenum is due to the higher acid susceptibility of the distal duodenum. Rapid epithelial repair of the duodenal mucosa in vivo provides an important protective mechanism against the aggression from luminal acid.

Animals↗
PubMed1988

Results of a rigorous follow-up system in colorectal cancer.

Results of a computer-aided follow-up programme for patients with colorectal cancer are analyzed. Between 1978 and 1987 1293 patients underwent this programme, the drop-out rate was 17%. 299 recurrences in 168 patients were discovered (40% local recurrence, 29% liver metastases and 31% others). Fifty-one per cent of patients with local recurrence and 47% with liver metastases were symptom free. Radical surgery could be performed in 50% of local recurrences and in 26% of liver metastases. The three year survival rate after radical surgery for recurrence was 35% for local recurrences and 33% for liver metastases, the five-year-survival rate 23% and 15%, respectively.

Cohort Studies↗
PubMed1988

Rectal cancer: factors influencing the development of local recurrence after radical anterior resection.

The study was designed to select criteria which influence the incidence of local recurrence after radical anterior resection for rectal cancer. Local recurrence developed in 18 patients (20%) out of 90. All patients entered a prospective clinical study for the detection of local recurrence (mean observation time: 50 months). The following criteria were evaluated retrospectively: age, sex, staging, grading, gross appearance of the tumour, lymphatic reaction, invasion of lymph- and blood vessels, perineural invasion, mucus production of the tumour and width of the distal margin of clearance (measurement in cm in the specimen immediately after resection). The incidence of local recurrence (%) depended on Dukes stage (A: 7%, B: 17%, C: 40%; p less than or equal to 0.03), grading (well differentiated: 5%, average: 20%, poorly differentiated: 55%; p less than or equal to 0.02), gross appearance (protuberant: 15%, infiltrating: 47%; p less than or equal to 0.006), lymphatic stroma reaction (yes: 10%, no: 45%; p less than or equal to 0.006), invasion of veins (yes: 75%, no: 20%; p less than or equal to 0.0002), perineural invasion (yes: 52%, no: 17%; p less than or equal to 0.001) and the margin of clearance (less than 1 cm: 52%; 1-3 cm: 10%, greater than 3 cm: 15%; p less than or equal to 0.02 Mantel, p less than or equal to 0.05 Breslow between less than 1 cm vs 1-3 cm and greater than 3 cm, respectively). Local recurrence was not related to age, sex and mucus production of the tumour. Unfavourable morphological criteria may help to define groups with a higher risk of developing local recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗