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  • 1
    Electronic Resource
    Electronic Resource
    Treatment of dysphagia in esophageal carcinoma: Transthoracic En-Bloc esophagectomy and reconstruction 48 hours later (1988)
    Springer
    Dysphagia 2 (1988), S. 222-227 
    Details
    ISSN: 1432-0460
    Keywords: Esophageal cancer ; Transthoracic esophagectomy ; Mediastinal lymphadenectomy ; Delayed reconstruction ; Blunt esophageal dissection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In 82 consecutive patients with esophageal cancer (90% squamous cell carcinoma, 10% adenocarcinoma) transthoracic “en bloc” esophagotomy with regional lymphadenectomy was performed. The reconstruction with gastric interposition was carried out with delayed urgency in a second operation 48–72 h after the initial procedure. The results of this group were compared to a group of 65 patients who had transmediastinal esophagectomy without thoractotomy and mediastinal as well as suprapancreatic lymphadenectomy and immediate reconstruction by gastric interposition. The number of postoperative risk situations concerning cardiopulmonary features were comparable in both groups. The 30-day mortality rate and postoperative morbidity was not significantly different between both patient groups (mortality rate: transthoracic: 6.6%, transmediastinal: 7.7%). The advantages of a 2-stage procedure are that esophagectomy and especially mediastinal lymphadenectomy can be performed precisely without time pressure. After 2 days the stomach is hypotonic and dilated as a result of truncal vagotomy and can easily be elevated to the neck. The interval of 48–72 hours was chosen because the postoperative right-to-left shunt has nearly normalized after this time period. En bloc esophagectomy and reconstruction with delayed urgency can be performed without disadvantages compared to a 1-stage procedure. It can especially be recommended for operations in which esophagectomy and mediastinal lymphadenectomy are difficult and wearisome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02414431
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  • 2
    Electronic Resource
    Electronic Resource
    Preserved incretin effect after complete surgical denervation of the pancreas in young pigs (1985)
    Springer
    Research in experimental medicine 185 (1985), S. 291-298 
    Details
    ISSN: 1433-8580
    Keywords: Pancreas denervation ; Pancreas transplantation ; Insulin secretion ; Gastric inhibitory polypeptide ; GIP ; Incretin effect
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Plasma insulin responses to intragastric (i.g.) (1.5 g/kg b.wt.) and “isoglycemic” intravenous (i.v.) glucose were measured in ten unanesthetized young pigs to assess the contribution of gastrointestinal factors to the total insulin secretion as observed after i.g. glucose. The participation of nerves was estimated by comparing metabolic tests performed before and after total surgical pancreatic denervation. In the five animals which survived the procedure, 52.6% of the insulin response after i.g. glucose was calculated to be due to incretion factors, a value similar to the 54.8% found in the preoperative series (with intact pancreatic innervation). The response of IR-GIP to i.g. glucose was not significantly different between preoperative and postoperative tests, although a subtotal duodenectomy had to be performed in the course of the operation designed to completely denervate the pancreas. Intragastric and i.v. (also tested by bolus glucose injection) glucose tolerance was almost identical before and after the operation. It was concluded that nerves do not seem to play a major role in mediating the incretin effect in pigs. Hormonal factors, including GIP, appear to be more important.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01851954
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  • 3
    Electronic Resource
    Electronic Resource
    The “Steakhouse syndrome” (1989)
    Springer
    Surgical endoscopy and other interventional techniques 3 (1989), S. 195-198 
    Details
    ISSN: 1432-2218
    Keywords: Food impaction of the esophagus ; Endoscopy ; Esophageal dysfunction ; Malignant tumors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Over a period of 5 years, 28 instances of acute food impaction of the esophagus were documented in 26 patients at our institution. In all patients the impacted bolus was successfully removed without complication using a flexible endoscope. Underlying diseases were identified during primary endoscopy in 31% of the cases. Further diagnostic workup was performed in all but 5 of the patients. After adequate evaluation pathologic findings were demonstrated in 90% of the cases (38% malignant and 52% benign diseases). Long-term therapy was deemed necessary in 17 of these 21 patients. Operative intervention was indicated in 4 cases, 2 of which were for malignant tumors. Acute food impaction should always be regarded as a symptom of esophageal disorders. In patients with esophageal cancer or other mediastinal tumors bolus impaction generally indicates an advanced tumor stage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02171545
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  • 4
    Electronic Resource
    Electronic Resource
    Thromboembolie-Prophylaxe in der Chirurgie — heute obligat? (1988)
    Springer
    Langenbeck's archives of surgery 373 (1988), S. 136-140 
    Details
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01262778
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  • 5
    Electronic Resource
    Electronic Resource
    19. Chirurgische Therapie des Plattenepithelcarcinoms des Oesophagus -erweiterte Radikalität (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 129-139 
    Details
    ISSN: 1435-2451
    Keywords: En-bloc-esophagectomy ; Esophageal carcinoma ; Standard esophagectomy ; Transmediastinal esophagectomy ; En-bloc-Oesophagektomie ; Oesophaguscarcinom ; Standard-Oesophagektomie ; Transmediastinale Oesophagektomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die Analyse des eigenen Krankengutes zeigt, dass die sog. en-bloc-Oesophagektomie nicht risikoreicher ist als vergleichbar limitierte Eingriffe wie die Standard-Oesophagektomie oder die transmediastinale Oesophagektomie. Die Letalität und die Komplikationen liegen jeweils im vergleichbaren Bereich (n = 147; Letalität:I 6,6%-,II 7,7%). Die Analyse der Überlebenszeiten von 83 Patienten mit Plattenepithelcarcinom des thorakalen Oesophagus ergibt eine 4-Jahres-Überlebenszeit von 54% für die T1/2-Kategorie. Dabei ist die Prognose von NO- und N1-Metastasierungen gleich, was als Erfolg der en-bloc-Resektion gewertet werden kann. Die Prognose der T3/4-Tumorkategorien ist wesentlich schlechter.
    Notes: Summary The analysis of our own patients shows that the so-called en-bloc-esophagectomy does not bear more risks compared to standard esophagectomy or transmediastinal esophagectomy. Lethality and complications are within comparable ranges (n = 147; lethality: 16.6%,II 7.7%). In 83 patients with squamous cell carcinoma of the thoracic esophagus the analysis of survival time shows a 4-year survival time in 54% for the T1/2-category. At the same time the prognosis is equal for both NO- and Nl-metastasis. This can be seen as a success of the en-bloc resection. The prognosis of the T3/4-tumor category is much worser.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297803
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  • 6
    Electronic Resource
    Electronic Resource
    21. Perioperative Chemotherapie bei Plattenepithelcarcinomen des Oesophagus (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 145-148 
    Details
    ISSN: 1435-2451
    Keywords: Esophageal cancer ; Perioperative chemotherapy ; Oesophaguscarcinom ; Perioperative Chemotherapie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Für die Mehrzahl der Patienten mit Oesophaguscarcinom sind lokale Tumorinfiltrationen und/oder Fernmetastasen bei der Diagnosestellung für die ungünstige Prognose verantwortlich zu machen. Zu deren Verbesserung werden zusätzliche Therapiemodalitäten - Chemotherapie allein oder in Kombination mit simultaner Strahlentherapie — perioperativ eingesetzt. Trotz einer möglichen Steigerung der Resektionsrate fehlen bisher überzeugende Ergebnisse, die angesichts der gesteigerten Toxizität einen Einsatz dieser multimodalen Therapiestrategien ausserhalb von kontrollierten Studien erlauben.
    Notes: Summary In the majority of patients with esophageal cancer local tumor infiltration and/or distant metastases are responsible for the poor prognosis. Therefore to improve life expectancy additional modalities - chemotherapy alone or in combination with simultaneous radiation - have been introduced perioperatively. In spite of a possible increase of resectability convincing data are lacking which could argue for an uncontrolled introduction of the neoadjuvant approach outside investigational studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297805
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  • 7
    Electronic Resource
    Electronic Resource
    191. Das Frühcarcinom des Oesophagus (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 843-844 
    Details
    ISSN: 1435-2451
    Keywords: Esophagus ; Early carcinoma ; Transthoracic esophagectomy ; Oesophagus ; Frühcarcinom ; Transthorakale Oesophagektomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Während die Häufigkeit des Oesophaguscarcinoms in China mit 16% und in Japan mit 7,6% angegeben wird, liegt sie im Patientengut der Chirurgischen Klinik bei 5,4% (n = 15). Das Frühcarcinom der UICC-Klassifikation entpricht den Stadien pT 1 a und 1 b der Japanischen Klassifikation. 60% waren Plattenepithelcarcinome, 40% Adenocarcinome im Endobrachyoesophagus. Zu 60% hatten auch die Plattenepithelcarcinome Frühsymptome im Sinne der Dysphagie (Adenocarcinome 100% dysphagische Beschwerden). Während beim Adenocarcinom die transmediastinale Oesophagektomie ausreichend erscheint, ist beim Plattenepithelcarcinom wegen der Lymphknotenmetastasierung im Stadium pT 1 die transthorakale Enbloc-Oesophagomediastinektomie mit Magenhochzug anzustreben.
    Notes: Summary In China 16% and in Japan 7.6% of the esophageal cancers observed are early carcinomas. In our institution we observed early carcinomas of the esophagus in 5.4% (n = 15) of the cases. Early carcinomas using the UICC classification are comparable to stage pT 1 a and I b with the Japanese classification. Sixty percent are squamous cell carcinomas; 40% adenocarcinomas of the endobrachyesophagus. Sixty percent of the squamous cell carcinomas showed early symptoms like dysphagia (adenocarcinomas, 100% dysphagia). In adenocarcinomas of the esophagus; transmediastinal esophagectomy seems to be an adequate therapy, whereas in squamous cell carcinomas the early lymph-node metastases observed in pT 1 tumors should be treated by thoracic enbloc esophagectomy and mediastinectomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01297975
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  • 8
    Electronic Resource
    Electronic Resource
    281. Sind die Ergebnisse nach Refundoplicatio schlechter als nach primärer Fundoplicatio? (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 900-900 
    Details
    ISSN: 1435-2451
    Keywords: Fundoplication ; Refundoplication ; Functional results ; Fundoplicatio ; Refundoplicatio ; Funktionelle Ergebnisse
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Von 7/82 bis 12/86 wurden 45 Fundoplikationen und 35 Refundoplikationen durchgeführt. Nach Refundoplicatio waren intra- und postoperative Komplikationen wesentlich häufiger; die Letalität betrug 0% für die Fundoplicatio und 3% für die Refundoplicatio. Bei der Nachuntersuchung nach im Mittel 30 Monaten unterschieden sich die funktionellen Ergebnisse nicht: Der Ruhedruck des unteren Oesophagussphincters lag im Normbereich (15 bzw. 12 mm Hg); pH-metrisch konnte in beiden Gruppen kein gastrooesophagealer Reflux mehr nachgewiesen werden. Trotz des höheren Operationsrisikos und höherer Morbidität im Vergleich zur Erstoperation ist die erneute Fundoplicatio aufgrund gleich guter funktioneller Ergebnisse auch für den Zweiteingriff gerechtfertigt.
    Notes: Summary From July 1982 to December 1986, 45 fundoplications and 34 refundoplications were performed. After refundoplication, the postoperative complications were more frequent. There was no postoperative deaths after fundoplication, but lethality was 3% after refundoplication. The mean follow-up time was 30 months; functional results were comparable in both groups: lower esophagus sphincter pressure was normal in both groups (15 and 12 mm Hg); no gastroesophageal reflux could be detected either. Despite a higher operative risk and higher morbidity, a fundoplication is justified if the primary procedure fails, since equally good results can be obtained.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01298065
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  • 9
    Electronic Resource
    Electronic Resource
    Zum Problem der Simultaneingriffe im Rahmen der Bauchchirurgie (1987)
    Springer
    Langenbeck's archives of surgery 370 (1987), S. 251-258 
    Details
    ISSN: 1435-2451
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01259312
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  • 10
    Electronic Resource
    Electronic Resource
    284. Intragastrale Langzeit-pH-Metrie zur Identifikation einer Risikogruppe für Rezidivulcera nach proximal gastrischer Vagotomie (PGV) (1987)
    Springer
    Langenbeck's archives of surgery 372 (1987), S. 901-902 
    Details
    ISSN: 1435-2451
    Keywords: Proximal gastric vagotomy ; Gastric secretion tests ; Intragastric long-term pH-monitoring ; Ulcer recurrence ; Proximal gastrische Vagotomie ; Magensekretionsanalyse ; Intragastrale Langzeit-pH-Metrie ; Rezidivulcus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In einem 4-Jahreszeitraum ( $$\bar x$$ 1,6 Jahre) blieben von 47 Patienten mit PGV wegen Ulcera duodeni 38 rezidivfrei, während 9 endoskopisch nachgewiesene Rezidivulcera entwickelten. Die 2–4 Tage präoperativ und am 10. postoperativen Tag durchgeführte Magensekretionsanalyse mit Stimulation durch Scheinfütterung bzw. Pentagastrin ergab keinen signifikanten Unterschied zwischen den Patienten mit bzw. ohne Rezidiv. Die einzige signifikante Differenz zwischen beiden Gruppen bestand in der postoperativen intragastralen pH-Metrie der Schlafphase für den Median-pH und den Prozentsatz der pH-Werte 52.
    Notes: Summary Forty-seven patients were followed-up for 4 years ( $$\bar x$$ 1.6 years) after PGV because of duodenal ulcers. Thirty-eight remained free of recurrent ulcers, whereas 9 developed new ulcers, which were verified endoscopically. The gastric secretion test, which was performed 2–4 days preoperatively and on postoperative day 10 with stimulation by sham feeding and pentagastrin, showed no significant differences between the patients with or without ulcer recurrence. The only significant difference between the two groups was found in postoperative intragastric pH-monitoring of the sleep-phase for the median pH value and a percentage of pH values of ≦ 2.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01298068
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