PubMed Health⌕ Search

Biomedical subjects

W Kneist

Publications and source records attributed to W Kneist.

At least 19 recordsLinked to original sources
PubMed2003

Anterior partial fundoplication for gastroesophageal reflux disease.

BACKGROUND: This study examined the effect of anterior partial fundoplication on reflux symptoms and dysphagia in gastroesophageal reflux disease. PATIENTS AND METHODS: Perioperative results in 249 patients were evaluated retrospectively for 93 conventional and prospectively for 156 laparoscopic procedures. The patients were followed up by standardized questionnaire. Median clinical follow-up period was 9 months (range 6-44) after laparoscopic and 88 months (range 15-194) following partial open fundoplication. RESULTS: The median operating time was 58 and 115 min for laparoscopic and open partial fundoplication. Intraoperative complications were rare (1%) for both approaches. After introduction of the laparoscopic procedure the morbidity rate was reduced (mean 3.2% vs. 1.3%) at a shorter postoperative hospital stay (10 vs. 5 days). No reflux symptoms were found in 71.4% patients after conventional and in 69% after laparoscopic partial fundoplication, dysphagia did not develop in 86% and 85%, respectively, and 66% and 82% received no medications. Among the patients with reflux symptoms 6.5% and 0.9% underwent revision surgery. Satisfaction with the surgical outcome was expressed by 78% and 85% of patients, respectively. CONCLUSIONS: Anterior partial fundoplication achieves effective medium- and long-term control of reflux symptoms. Technically easy to perform and associated with few complications, the procedure is superior to fundoplication with respect to the development of postoperative dysphagia and therefore represents a viable alternative to fundoplication.

Deglutition Disorders↗
PubMed2003

[Total excision of the mesorectum in cancer of the lower and middle rectum. Oncological and functional results].

INTRODUCTION: The introduction of total mesorectal excision (TME) in the treatment of rectal cancer has improved survival rates and decreased recurrence. Our objective was to analyse perioperative data as well as the results of the follow-up examination. Risk-factors for local recurrence should be identified since the indication for adjuvant therapy in "optimal surgery" has to be redefined. PATIENTS AND METHODS: Between March 1997 and December 2001, 108 patients with adenocarcinoma of the lower and middle rectum were operated on by three surgeons according to the concept of total mesorectal excision. In 75 (69.4%) patients,a lower anterior resection and in 32 (29.2%) cases an abdominoperineal resection was performed. One patient received a Hartmann's resection. There were 15 cases of stage IV (UICC) present and in 53 patients the tumor extension was restricted to the wall. Demographic and perioperative data as well as the results of the follow-up examination were registered prospectively. The median follow-up period amounted to 24 months (2-56). RESULTS: A total of 87 patients underwent a curative resection. Fourteen lymph nodes were dissected (median). Pelvic autonomic nerve preservation was possible in 90 patients. The median intraoperative blood loss was 500 ml. As surgical complications, anastomotic leakage occurred in 18% of cases, perineal wound infection in 33%, and bladder dysfunction (requiring catheterisation) in 5.6%. The overall rate of recurrence was 17.5%. The rate of local recurrence was 4.9% and the survival rate was 91% over 3 years. Risk factors for local recurrence are N2-disease, transmural growth and tumor localisation in the lower third of the rectum. CONCLUSIONS: TME offers good oncological and functional results with low complication rates for the treatment of cancer in the middle and upper third of the rectum. Interdisciplinary multicenter studies are still necessary to redefine the place of adjuvant radiation and chemotherapy in cases of cancer in the lower two thirds of the rectum and stage III disease.

Adenocarcinoma↗
PubMed2003

[Indicators of quality in surgical treatment of rectal carcinoma].

INTRODUCTION: For the assessment of surgical therapy for rectal cancer, perioperative and oncological as well as aspects of quality of life have to be taken into consideration. The objective of the present analysis was to identify indicators allowing assessment of the quality of the surgical intervention. PATIENTS AND METHODS: Between March 1997 and August 1998,50 patients with adenocarcinoma of the rectum were operated on by five surgeons according to the concept of total or partial mesorectal excision. In 4 patients an anterior, in 35 a low anterior resection, and in 11 an abdominoperineal resection was performed. There was a stage IV (UICC) present in 9 cases, and in 18 patients the tumor extension was restricted to the wall. The demographic and perioperative data as well as the results of the follow-up examination were registered prospectively. The median follow-up period amounted to 44 months (5-57). RESULTS: Intraoperative parameters showed no differences concerning the individual operating surgeons. General complications arose in 9 (50%) and surgical complications in 34 (68%) patients. Anastomotic leakage (5/39), perineal wound infection, and bladder dysfunction (requiring catheterization for bladder emptying) occurred as frequent complications and there were differences with regard to the surgeon. The rate of local recurrence was different and was between 0% and 75% for the individual surgeons. CONCLUSIONS: For the assessment of surgery for rectal carcinoma, only a few parameters are necessary. As indicators of quality after rectal resection, the rate of anastomotic leakage should be registered; after abdominoperineal resection, the rate of perineal wound infection, the ratio of postoperative bladder dysfunction, and the locoregional rate of recurrence should be registered.

Adenocarcinoma↗
PubMed2003

[Anterior semifundoplication in the treatment of gastroesophageal reflux disease: long-term results following conventional surgery].

INTRODUCTION: According to randomized studies, semifundoplication in the treatment of gastroesophageal reflux disease (GERD) is related to lower postoperative dysphagia rates than with fundoplication in comparable reflux controls. However there is a lack of long-term results. The object of this study was therefore to determine the influence of partial anterior fundoplication on the long-term clinical outcome (>1 year) in patients with GERD. METHOD: From December 1986 until May 2000, 100 patients suffering from GERD were operated on. Seven of them were not evaluated, four because of revisional surgery, two because of preceding multiple abdominal operations (MEN, colitis ulcerosa), and one because of Nissen fundoplication. In all, the perioperative results of 93 patients (51 men and 42 women aged 21 to 86 years) were evaluated. Fourteen patients died during the follow-up period and two were lost because of changes in address. Thus, 77 patients with a median follow-up of 88 months (range 15-94) were interviewed with a list of standardized questions concerning reflux control and dysphagia. RESULTS: The median operation time was 110 m (range 55-270). In one patient, an esophageal mucosal tear was detected intraoperatively and promptly repaired. Postoperatively, 71.4% (55/77) had no reflux complaints, 85.7% (66/77) had dysphagia, 66.2% took no further medication, and 31.2% (24/77) continued taking medication. The median interval free of symptoms was 25.5 months, and in 40.9% of the patients, symptoms recurred within the first year after operation. Five patients were in need of reoperation. A total of 77.9% of the patients were satisfied with the results of the operation. CONCLUSIONS: With regard to reflux control, long-term results of anterior semifundoplication are comparable to those of fundoplication. However, considering postoperative dysphagia, the technically easier anterior semifundoplication is less eventful and therefore a good alternative which in the long run shows good results after laparoscopic intervention.

Adult↗
PubMed2003

Influence of identification and preservation of pelvic autonomic nerves in rectal cancer surgery on bladder dysfunction after total mesorectal excision.

PURPOSE: Given the improvement in oncologic outcome after the introduction of total mesorectal excision for the treatment of rectal cancer, the objective of the present study was to determine the frequency of identification and preservation of the pelvic autonomic nerves and to identify a possible link between postoperative micturition disturbances and the extent of the radical resection. METHODS: Between March 1997 and December 2001, 150 patients with adenocarcinoma of the rectum (<or=16 cm from the anal verge) underwent surgery, with sphincter preservation in 112 cases (74.7 percent). Sixty-three patients (42 percent) were classified as American Society of Anesthesiologists Stage III and two (1.3 percent) as Stage IV. The number of cases with complete identification, partial identification, or nonidentification of the autonomic nerves (superior hypogastric plexus, hypogastric nerve, and inferior hypogastric plexus) was documented and correlated with micturition disturbances (need for a long-term urinary catheter). Urine volumes were measured by ultrasound before and after surgery. RESULTS: The pelvic autonomic nerves were identified completely in 108 patients (72 percent), partially in 16 (10.7 percent), and not at all in 26 (17.3 percent). After the initial phase of the study (n = 50 patients), complete identification was realized in 78 percent of cases. Multivariate analysis showed that of the predetermined parameters (learning curve for Group I vs. Groups II or III, gender, T stage, blood loss, curative surgery, and previous surgery), gender (P = 0.006), learning curve (P = 0.019), and depth of penetration of the rectal wall (T1/T2 vs. T3/T4; P = 0.028) exerted an independent influence on achievement of complete pelvic nerve identification. Sixteen patients (10.7 percent) were discharged from the hospital with a urinary catheter. Identification and preservation of the pelvic autonomic nerves was associated with low bladder dysfunction rates (4.5 vs. 38.5 percent; P < 0.001). In the evaluation of preoperative and postoperative bladder function, a urologic history and residual urine volume measurements by ultrasound were essential. The information obtained from urodynamic studies was of no relevance. CONCLUSIONS: Identification and preservation of the pelvic autonomic nerves was achieved in the majority of patients and led to the prevention of urinary dysfunction. Gender (P = 0.006), learning curve (P = 0.019), and T stage are independent parameters that influence outcome.

Adenocarcinoma↗
PubMed2003

[18F-Deoxyglucose PET for the staging of oesophageal cancer: influence of histopathological subtype and tumour grading].

AIM: Evaluation of the influence of histopathologic sub-types and grading of primaries of oesophageal cancer, relative to their size and location, on the uptake of (18)F-deoxyglucose (FDG) as measured by positron emission tomography (PET). METHODS: 50 consecutive patients were evaluated. There were four drop-outs due to previous surgical and/or chemotherapeutical treatments and thus in 46 patients (28 squamous cell carcinomas and 18 adenocarcinomas) a pretherapeutic PET evaluation of the primary including a standard uptake value (SUV) was obtained. In 42 cases data on tumour grading were available also. RESULTS: Squamous cell carcinomas (SCC) were in 7/13/8 cases located in the proximal, medial and distal part of the oesophagus, respectively the grading was Gx in 3, G 2 in 12, G2-3 in 7, and G3 in 6 cases. The SUV(max) showed a mean of 6.5+/-2.8 (range 1.7-13.5). Adenocarcinomas (ACA) were located in the medial oesophagus in two cases and otherwise in its distal parts. Grading was Gx in one, G2 in 4, G2-3 in 3, G3 in 3, G3-4 in 3, and G4 in one case. The mean SUV(max) was 5.2+/-3.2 (range 1-13.6) and this was not significantly different from the SCC. Concerning the tumour grading there was a slight, statistically not relevant trend towards higher SUV(max) in more dedifferentiated cancer. DISCUSSION: SCC and ACA of the oesophagus show no relevant differences in the FDG-uptake. While there was a significant variability of tumour uptake in the overall study group, a correlation of SUV and tumour grading was not found.

Adenocarcinoma↗
PubMed2002

[Positron emission tomography for the preoperative staging of esophageal carcinoma].

BACKGROUND AND OBJECTIVE: Exact preoperative staging is a prerequisite for the indication as well as the choice of the appropriate operative technique for patients with esophageal carcinoma. In this prospective study we assessed whether positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) increases the accuracy of staging compared to standard computer tomography (CT) and leads to a different therapeutic approach. PATIENTS AND METHODS: 30 patients (25 men, 5 women, median age 63 years) with histologically identified carcinoma of the esophagus (n =29) and the cardia (n = 1), respectively, were studied. All patients underwent FDG-PET imaging of the neck, chest, and abdomen as well as CT of the chest and abdomen. Sensitivity, specificity and accuracy were calculated for FDG-PET and CT to evaluate the detection of histologically identified lymph node metastases and distant metastatic disease. RESULTS: FDG-PET showed higher specificity whereas the accuracy of the CT proved to be higher not only for the detection of abdominal lymph node metastases (67 % vs. 46 %), but also for lymph node metastases of the thorax (71 % vs. 50 %). Furthermore, the accuracy of the CT for the detection of blood-bone and lymphatic distant metastases was also higher than that of FDG-PET (72 % vs. 68 %). FDG-PET was more specific (100 % vs. 71 %) albeit less sensitive than CT-imaging (27 % vs. 73 %). CONCLUSION: In our study, FDG-PET did not increase the accuracy of standard staging (CT) in patients with carcinoma of the esophagus. Therefore, no new consequences resulted for the operative indication as well as therapeutic procedure. Due to the high costs involved with PET investigation, this form of staging is momentarily indicated mainly for use in clinical studies, and in cases where CT does not offer unequivocal results. Increase in sensitivity of the already advantageous whole-body FDG-PET imaging by means of tumor-affinitive radiopharmaceuticals as well as optimized apparatus resolution could lead to new indications for this staging procedure.

Carcinoma↗
PubMed2002

[Esophageal resection in treatment of achalasia. 4 case reports and review of the literature].

In the time period between 1985 and June 2001, four of 81 patients diagnosed with achalasia were surgically treated by means of transhiatal esophageal resection. Replacement with stomach and cervical anastomosis was performed in three patients aged 8, 19, and 27 years, respectively, after initial myotomy. In one case, the esophagus resection was the primary surgical measure and the colon was used as the replacement. The preoperative symptoms of the four patients showed improvement 51, 34, 15, and 8 months after the operation, respectively. Dysphagia and regurgitation no longer occurred. One patient died 4.5 years after esophageal resection due to ulcerous bleeding of the distal redundant colon interposition. In accordance with other studies investigating serious swallowing disorders, it could be shown that transhiatal resection with esophagus-replacement through stomach pull-up can lead to symptom-relief as well as an improvement in the quality of living.

Adolescent↗
PubMed2002

[Long-term outcome of myotomy and semi-fundoplication in achalasia].

The basic principle behind the treatment of achalasia consists of alleviating swallowing disorders by reducing resistance in the lower esophageal sphincter without inducing gastroesophageal reflux. Only a few studies are available on long-term results after operative treatment. Fifty-one patients were studied with regard to long-term results after open transabdominal extramucosal myotomy of the distal esophagus along with partial anterior fundoplication (Dor procedure). Clinical data were collected by standardized interviews, and symptoms were assigned a score ranging from 0 to 3 according to severity and frequency. The pre- and postoperative symptoms were comparable in 50 patients. The median duration of follow-up was 88 months (range: 12-160 months). Operative time was a median of 80 min. Two esophageal mucosal tears were recognized intraoperatively and promptly repaired. Postoperative morbidity occurred in two patients (3.9%). Very good or good long-term results after surgical therapy were achieved in 49 patients (96.1%). Forty-seven patients (92.2%) have no or rare dysphagia. The frequency of regurgitation as well as chest pain was also significantly reduced after surgery. Forty-nine patients (96.1%) either maintained or gained weight. Preoperative duration of symptoms, follow-up, age, and gender had no influence on the results (p > 0.05). Two patients (3.9%) mentioned occasional heartburn. Five patients (9.8%) took or still take proton pump inhibitors postoperatively. Severe stage IV symptoms due to peptic stricture and dolichomegaesophagus required reoperation in one patient (2%). The results show that myotomy and the antireflux procedure (semifundoplication) lead to long-term relief of dysphagia without inducing reflux at a low operative risk. Since long-term results are as yet not available for minimally invasive surgery, it remains to be seen if this operative technique will become the primary surgical procedure for this disease.

Adolescent↗
PubMed2002

[Adenocarcinoma of the esophagus: prognostic comparison between transthoracic esophageal resection with expanded 2-field lymph node dissection and trans-hiatal esophageal dissection with abdominal lymph node excision].

A retrospective analysis should compare the two operative approaches, transhiatal or transthoracic resection in patients suffering from adenocarcinoma of the esophagus. Between 1985 and 2002 123 cases were presented with adenocarcinoma of the esophagus, treated in 65% by transhiatal resection including abdominal lymph node dissection and in 35% by the transthoracic approach with standardized extended mediastinal and abdominal lymph node dissection. Hospital mortality was 14% (6/43) after transthoracic resection and 3.8% (3/80) after transhiatal resection (ns). Die number of removed and examined abdominal lymph nodes following transhiatal resection was 14.1 (mean) versus 12.3 (mean) after transthoracic resection (ns). Die number of removed and examined mediastinal lymph nodes by transhiatal resection was 6.3 (mean) versus 19.7(mean) after transthoracic resection (p < 0.001). The median survival after transthoracic approach was 19 months versus 20 months after transhiatal approach (ns). Median survival of curatively resected patients (R0) were in both operative procedures similar (21 months). A more differentiated analysis referred to the UICC stages also demonstrated no differences in the survival between transthoracic and transhiatal resection. With respect to less mortality and less morbidity after transhiatal resection and because of the not detectable prognostic advantage of the transthoracic resection we suggest the transhiatal approach as the treatment of choice in patients with adenocarcinoma of the esophagus.

Abdomen↗
PubMed1995

[Clinical double-blind trial of topical zinc sulfate for herpes labialis recidivans].

In a placebo controlled, double-blind clinical trial in patients with herpes labialis recidivans, zinc sulfate (CAS 7733-02-0) as gel (Virudermin Gel) proved to be significantly more effective than the gel alone. With zinc sulfate as gel, the symptoms were less marked and healing was faster. This simple preparation can be applied in cases of herpes labialis recidivans without any risk of side effects. Due to the antiseptic properties of zinc sulfate superinfections can be prevented.

Administration, Topical↗
PubMed1988

Symptomless postoperative thrombosis of the deep calf veins--treatment and prognosis.

Deep calf vein thrombosis in the rule can be diagnosed by objective methods like 125I fibrinogen up take test only. But if the diagnosis is done, we have to cure because the risk of the single case is not calculable prospectively. After our therapy we never saw neither progressive development of the thromboembolic process, nor haemorrhagic complications.

Adult↗
PubMed1988

[Training and conditioning in atopic patients following high altitude climate therapy].

The subjective and objective values have changed after a four weeks treatment in high mountain areas under cool climatic conditions. "Terrainkuren" (mountain walking under guidance of a therapist) under cool climatic- and body temperature conditions show besides training results (in sport medicine) also favourable thermoregulatory adaptations. Improvements of the endurance training can be objectivated by means of the reduced heart frequency and the decrease in lactit acid under standardized physical exercises. The simultaneous changes of thermoregulation can be looked upon as part of the reaction of the whole body (also called inurement). Both, the improvement of the training condition and the thermoregulatory change seem to support each other. Thus patients can train more effectively under the same standardized physical training, but cooler conditions. The decrease of comfort temperature of patients is due to the thermoregulatory adaptation. There is a considerable decrease in the sensibility to cold. The training in high mountain areas causes an improvement in the well being and behaviour of the atopic patients which can still be manifested three months after the therapy.

Acclimatization↗
PubMed1987

[Ergotism within the scope of the postoperative prevention of thromboembolism].

Vasospastic reactions (ergotism), a complication in postoperative prophylaxis against thrombo-embolism, using heparin-dihydroergotamine, are assessed in this paper on the basis of the authors' own observations and following evaluation of 19 literature references. The authors feel that the above combination of active substances may be recommended also for the future in routine prophylactic medication to prevent thrombo-embolism.

Dihydroergotamine↗