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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 383 (1998), S. 397-401 
    ISSN: 1435-2451
    Keywords: Key words Rectal cancer ; Surgery ; Coloanal anastomosis ; Postoperative function
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Nowadays surgery offers a complete spectrum of techniques for the treatment of rectal cancers. Progress in preoperative diagnostic techniques, especially in endoluminal ultrasound, and in the knowledge of anorectal physiology allows the surgeon to adopt a very individual strategy for the various tumor types. The situation has changed even for tumors of the middle and distal thirds of the rectum, which formerly were treated predominantly by abdominoperineal exstirpation. These can also be treated by sphincter-preserving techniques, the most ambitious of which is intersphincteric resection with coloanal anastomosis. Our experience shows that this method is not only comparable to the alternatives of conventional anterior resection and extirpation in terms of postoperative morbidity and mortality but also achieves excellent oncological results. Of course, anorectal function is significantly altered by this type of surgery. Still, after an adaptive period of about 6–12 months a very satisfactory functional result is reached. Further functional improvement, especially in the early postoperative period, can possibly be expected from reconstruction with creation of a colon pouch.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1530-0358
    Keywords: Intraluminal bypass ; Biodegradable biomaterials ; Intestinal anastomoses ; Experimental peritonitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The purpose of this experimental study was to affirm the protective effect of biodegradable tubes for the intraluminal bypass procedure under the adverse condition of general peritonitis. General peritonitis was induced by means of the cecal ligation and puncture (CLP) model in the rat. The leakage rate in the control group (n=20) without anastomotic protection was 70 percent (14/20). In three therapeutic groups, each consisting of 20 animals, the intestinal anastomoses were protected by an intraluminal bypass tube of different biodegradable biomaterials (collagen-II, BCL-002, and BCL-004). The best results were noted in the collagen-II and BCL-002 groups, where the leakage rates could be reduced to 10 percent. These highly significant results (P=0.0001) prove the feasibility of biodegradable biomaterials for the intraluminal bypass procedure in the rat, even in cases with underlying peritonitis.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1530-0358
    Keywords: Ileoanal anastomosis ; Continence ; Anal pressure ; Internal sphincter relaxation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was done to determine the effect of the direct ileal pouch-anal anastomosis upon pressure and sensory components of the anal canal and ileal pouch. These findings were related to postoperative continence. Thirty-three patients with ileal pouch-anal anastomosis (25 continent, eight with episodic minor incontinence) were studied 3±0.3 and 25±5 months after ileostomy takedown. The maximum resting pressure in the anal canal was significantly lower in patients with an imperfect result (35±5 mm Hg) than in continent patients (44±5 mm Hg) (P〈0.05). Postoperatively the maximum squeeze anal pressure was slightly greater in continent than in incontinent patients (99±8 mm Hg vs.87±7 mm Hg) (P〉0.05). The postoperative recto-(ileo-)anal inhibitory reflex was present in 27 percent. The linear correlation between strength of rectal (ileal) distension and depth resp. duration of internal sphincter relaxation as preoperatively observed disappeared postoperatively in every group of patients. Simultaneous measurements of pouch and anal pressure in patients with imperfect results revealed a reduced positive pouch anal pressure gradient compared to the continent group. This low pouch-anal pressure gradient is thought to be responsible for the increased incidence of soiling in some of our patients.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 338 (1975), S. 1-8 
    ISSN: 1435-2451
    Keywords: Restraint Stress ; Stress Ulcer ; Portocaval Anastomosis (PCA) ; Vagotomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung An Ratten mit portocavaler Anastomose (PCA) wurde die Auslösung und Verhütung von Streßulcera untersucht. Als Streßmodell diente der „restraint stress”. Nach 19stündiger Immobilisation in Gipsmanschetten zeigten die PCA-Tiere doppelt so viele Ulcera wie die scheinoperierten Kontrolltiere. Nach selektiver gastraler sowie trunkulärer Vagotomie reduzierte sich die Ulcusausdehnung und -anzahl auf etwa ein Fünftel. Doch zeigten die PCA-Tiere auch jetzt noch mehr Ulcera als die Kontrolltiere. Dieser Befund wird als Ausdruck gesteigerter Ulcusanfälligkeit nach PCA gewertet. Die Ursache ist entweder in lokalen Veränderungen der Schleimhaut oder Steigerung der intestinalen Phase der Magensaftsekretion zu werten. Für den Normalfall stellt aber die Vagotomie eine wirksame Prophylaxe gegen Streßulcera nach PCA der Ratte dar, da die nicht-vagalen ulcerogenen Faktoren allein zur Geschwürsbildung nicht ausreichen.
    Notes: Summary The provocation and prevention of stress ulcers in rats with portocaval anastomosis (PCA) have been studied. Model of stress was the „restraint stress”. After 19 hrs of immobilization in plaster cuffs the PCA-animals showed twice as many ulcers as the sham operated animals. After selective gastric or truncal vagotomy the extent and number of ulcers decreased to a fifth. Nevertheless the PCA-animals showed more ulcers than the control animals. These findings are being considered as an expression of a greater susceptibility to ulcers after PCA. The cause seems to be either a local alteration of the mucosa or an increase of the intestinal phase of gastric juice secretion. Under normal conditions the vagotomy represents an effective prevention of stress ulcers after PCA in the rat, as the non-vagal ulcerogenic factors alone don't suffice to provoke ulcers.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 336 (1974), S. 1-14 
    ISSN: 1435-2451
    Keywords: Diverticulosis ; Diverticulitis ; Incomplete Diverticle
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Ausgehend von den pathogenetischen Erkenntnissen der letzten Jahre wird auf die besondere Bedeutung des inkompletten Divertikels für das Syndrom Divertikulitis hingewiesen. Die lymphoepitheliale Struktur dieser mit dem kompletten Divertikel vergesellschafteten Form erklärt die Neigung zu chronischen, rezidivierend aufflackernden Entzündungen, die zu disseziierenden Phlegmonen der Darmwand mit konsekutiven Darmwandperforationen führen können. Die pathogenetisehe Bedeutung des inkompletten Divertikels liegt in der Schrittmacherfunktion für die Komplikationen der Divertikulitis. Der Nachweis inkompletter Divertikel im Colonkontrasteinlauf an Hand indirekter und direkter Zeichen ist ein wichtiges Indiz für die Prognose der Erkrankung. Eine konservative Therapie wird in diesen Fällen zum Scheitern verurteilt sein, da sie die schleichende Progredienz der Erkrankung nicht aufhalten kann. Nur die frühzeitige, ausreichend bemessene Resektion kann einen nachhaltigen Heilungserfolg sichern. Das Risiko dieses Eingriffes liegt mit 2,2% heute im Bereich des therapeutisch Vertretbaren.
    Notes: Summary Based on the pathogenetic knowledge of diverticular disease the importance of incomplete diverticula is elucidated. The lymphoepithelial tissue structure of incomplete diverticula indicates the tendency for chronic inflammatory disease, which leads to dissecting phlegmons of the wall of large bowels. Perforation of the colon may occur. The pathogenetic importance of incomplete diverticula is seen in the pacemakerfunction for complications of diverticulitis. The radiological proof by barium enema shows indirect and direct signs of incomplete diverticula. This is an important feature in diagnosis and prognosis. Conservative therapy is usually of little value because of the chronic advance of this disease. Only early and extensive resection of large bowel proves compatible success. In view of the complication the surgical risk — 2,2% — is accountable.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 345 (1977), S. 187-192 
    ISSN: 1435-2451
    Keywords: Gastric ulcer, pathogenesis ; Duodenal ulcer, pathogenesis ; Ulcus duodeni et ventriculi ; Pathogenese
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: ZusammenfaBung „Wer behauptet, das ideale Verfahren zur Behandlung des Magengeschwürs gefunden zu haben, muB als unbescheiden gelten.” Dieser Satz von Schnitzler (1914) gilt im Prinzip bis heute. Pathogenese und operative Verfahren sind nicht kongruent. Es mangelt noch am schlüBigen Konzept der Pathogenese. In kleinen Schritten werden weitere pathogenetische Faktoren und Fakten bekannt, so u. a. für das Ulcus duodeni lokal wirksame chemische Noxen (z. B. Propionitril) für das Ulcus ventriculi der Reflux von Duodenalsaft (z. B. Lysolecithin), der die Schleimhautbarriere vom Magen zu korrodieren vermag. Die derzeit bekannten pathogenetischen Mechanismen werden im einzelnen für die üblichen Geschwürslokalisationen dargestellt.
    Notes: Summary “Anyone who claims to have discovered the ideal procedure in the treatment of gastric ulcer, should be considered immodest.” These words by Schnitzler (1914) are in principle still valid. The pathogenesis and operative procedure are not identical. There is still no conclusive proof of the pathogenesis. The disclosure of other pathogenetic factors and facts is gradual. Locally active chemical noxae (e.g., propionitril) are responsible for the development of duodenal ulcer. Gastric ulcer is caused by the reflux of duodenal juice (e.g., lysolecithin, which is capable of corroding the mucosal barrier of the stomach. The current pathogenetic mechanisms of ulcer of the usual locations are specified.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 69 (1998), S. 1291-1291 
    ISSN: 1433-0385
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1248-9204
    Keywords: Collagen I ; Collagen III ; Hernia ; Fascia transversalis ; Surgical mesh
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of this study was to substantiate the hypothesis as to whether an altered metabolism of type I and type III collagen should be included as pathophysiological considerations of inguinal hernia development or not. Therefore, fascia transversalis derived from patients with indirect hernias (n=9), direct hernias (n=7) and from controls (n=7) were investigated both by immunohistochemistry and protein analysis (Western Blot). Both immunohistochemical analysis and Western Blot analysis showed that the ratio of the relative amounts of type I to type III collagen was significantly decreased in the fascia transversalis of patients with indirect and direct inguinal hernias compared with controls (p〈0.001). The relative reduction of the collagen I/III ratio may be explained by a concomitant increase in collagen type III synthesis in both hernia-families. In contrast to the control group there was no significant difference between patients with direct and indirect hernia. It is concluded that the change in collagen type I / III ratio, with the resulting altered physical properties, might essentially predispose individuals to the development of inguinal hernia. Thus, an altered collagen metabolism would provide an additional theoretical basis for the use of alloplastic materials, such as surgical meshes, and an explanation for the disappointing high recurrence rates after appropriate primary hernia repair, particularly if mesh-free techniques have been used.
    Type of Medium: Electronic Resource
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  • 9
    ISSN: 1248-9204
    Keywords: Incisional hernia ; Marlex mesh ; Abdominal wall compliance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In view of the poor results of suturing techniques, incisional hernias are often best repaired with biomaterials. Their use brings the recurrence rate to below 10%, but patients sometimes complain of discomfort and restricted abdominal mobility. We report our experience with 41 patients after implantation of a Marlex®-mesh in a preperitoneal, retromuscular position (mean follow-up period 16.7 months). The effect of implanted meshes on abdominal wall mobility was measured noninvasively with the aid of three dimensional stereography and compared with a non-operated healthy control group (n = 21). The commonest early postoperative complication was seroma in 32% of cases, usually relieved by aspiration. Infection and hematoma were less frequent at 4.9% and 12.2% respectively. Three patients developed a recurrent hernia. During follow-up 7.3% experienced pain during heavy activities, 29.3% during daily activities and 4.9% at rest. Three dimensional stereography showed a highly significant (p 〈 0.001) decrease in abdominal wall mobility following mesh implantation, compared to a non-operated control group. Improved composition of the mesh material involving a smaller proportion of polypropylene and greater elasticity, should be considered for the future, in order to reduce patient discomfort.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1248-9204
    Keywords: Contralateral hernia ; Children ; Incidence ; Predisposing disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary It is impossible to determine whether or not a child will develop a contralateral hernia after inguinal hernia repair. There exists no risk score for the occurrence of a contralateral hernia. This well-known fact prompted us to perform the underlying study. In a retrospective trial, we reviewed the files of all children operated on for inguinal hernias in our department from January 1986 until December 1994. During this period, we performed 1721 hernia repairs on 1708 children aged 0–16 years. In 96 (5.6%) of these patients, the indication to operate was a contralateral hernia following previous unilateral repair. Comparison of the ages at the time of primary inguinal repair of those children who developed a contralateral hernia (n=96) and those who did not (n=1612) showed a significantly increased incidence of contralateral hernias if the primary operation was performed before the age of two months (p〈0.0001). Diseases predisposing to hernias were found in 38% of all children (prematurity, dystrophia, ventriculo-peritoneal shunt, ascites, asthma). The authors recommend a contralateral exploration for children under the age of two months if they have any predisposing disease.
    Type of Medium: Electronic Resource
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