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  • 1
    ISSN: 1432-0460
    Keywords: Zenker's diverticulum ; Cervical myotomy ; Diverticulectomy ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgery for the treatment of Zenker's diverticulum was performed at our institution in a total of 43 patients over 6½ years. Cervical myotomy with diverticulectomy was performed in 32 of the patients and myotomy alone in 11. Mortality totaled 0%, with a reversible lesion of the recurrent nerve occurring in 7%. In 60% of the cases investigated preoperatively (N=40), motility disorders of the upper esophageal sphincter (UES) could be demonstrated using manometry as well as with cineradiography in 92% of the patients. Follow-up studies in 39 of the cases 25 months (mean) postprocedure indicated 82% of the patients to be symptom-free, with the remaining 18% demonstrating a marked improvement. Postoperative manometry as well as cineradiography carried out in 12 patients revealed the presence of UES motility dyscoordination in 8% and 25%, respectively. There were, however, no signs of recurrence of the diverticulum. The high number of patients in our study group demonstrating motility disorders of the UES emphasizes the need for cervical myotomy as part of the surgical therapy for Zenker's diverticulum.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0460
    Keywords: Gastroesophageal reflux ; Esophageal motility ; Ambulatory esophageal manometry ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The interplay between esophageal motility and gastroesophageal reflux (GER) was investigated with a new ambulatory system of 24-h monitoring of intraesophageal pressures and pH (MP24). The technique allows for simultaneous digital recordings and off-line data analysis. Both computer-aided and visual analyses were used, and algorithms for intercorrelation of mano- and pH-metry were developed. In a group of normal volunteers the physiological response of esophageal motility on GER was defined. In unselected patients suffering from GER disease, the esophageal motility prior to and during GER events was analyzed. In healthy people, most GER episodes occurred spontaneously and were cleared from the distal esophagus by peristaltic contractions. In GER patients, reflux episodes were often preceded by irregular contractions; during GER, esophageal motility was less often peristaltic compared with controls. Therefore, we conclude that MP24 gives relevant information in GER disease which might help in selecting patients for medical or surgical therapy.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-0460
    Keywords: Gastroesophageal reflux disease ; Diagnosis ; pH monitoring ; Diagnostic studies ; Deglutition ; Deglutition disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Gastroesophageal reflux disease (GERD) is one of the most frequent benign diseases of the gastrointestinal tract and in some cases the diagnosis may be very difficult. There are many diagnostic procedures but none of them could prove or definitely exclude the disease. The 24-h pH-monitoring is the “gold standard” for detection of gastroesophageal reflux and in many patients the reflux correlates with the GERD. The evaluation of a diagnostic method has to be done in a similar manner to the evaluation of therapeutic study (phase 1 to phase 4). For the definition of the “gold standard” for detection of a special diagnosis (e.g., the gastroesophageal reflux disease), the results of phase 3 studies for different methods had to be compared. The method with the best values for sensitivity and specificity is yet to be discovered. Until now, pH monitoring has been the gold standard for the diagnosis of GERD. However, there are many problems connected with using this method in clinical practice.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1435-2451
    Keywords: Acute gastroduodenal lesions ; Intragastric pH ; Cimetidine ; Ranitidine ; Akute gastroduodenale Läsionen ; Intragastraler pH ; Cimetidin ; Ranitidin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 12 beatmete Intensivpatienten mit Peritonitis bzw. Sepsis wurden in einer prospektiv randomisierten Doppelblindstudie mit 300 mg Ranitidin/d bzw. 2 g Cimetidin/d jeweils über Dauerinfusion behandelt. Beide Untersuchungsgruppen waren hinsichtlich Alter, Geschlecht und Gefährdungsgrad streßinduzierter Blutungen vergleichbar. Durch Ranitidin gelang eine zur Blutungsprophylaxe ausreichende, wenn auch nicht vollständige Kontrolle des intragastralen pH-Wertes. Mit Cimetidin als Monotherapie konnten wir dagegen selbst in einer hohen Dosierung (2 g/d) bei unserem Patientengut keine ausreichende Kontrolle des Magen-pH-Wertes erzielen. Für 3 Patienten erwies sich sogar die Kombination von Cimetidin mit 2 × 10 mg Pirenzepin/d als nicht ausreichend.
    Notes: Summary Twelve patients in an intensive care unit on a respirator who had peritonitis or sepsis were treated with 300 mg/day of ranitidine or 2 g cimetidine/day, which was administered via perfusor infusion under the conditions of a random double-blind study. Both groups under study were comparable with respect to age, sex, and grade risk of stress-induced bleeding. With ranitidine, we were able to control bleeding sufficiently, but not completely control intragastric pH values. With cimetidine as monotherapy, however, even under the high dosage of 2 g/day, we were not successful in controlling intragastric pH. With three patients even the combination of ranitidine and 2 × 10 mg pirenzepine/day did not prove sufficient.
    Type of Medium: Electronic Resource
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