Leber, Magen, Darm最新文献

The principle of histology-and stage-oriented cancer treatment generally adopted in modern oncology is realizable and desirable also in surgery for stomach carcinoma. Instead of a single standard operation for all gastric carcinomas surgical procedure should be individualized. Curative local therapy as endoscopic polypectomy or mucosal resection or laparoscopic intraluminal surgery is possible only in a limited number of patients. In all other patients radical resection is indicated, either as subtotal distal gastrectomy or as total gastrectomy, if necessary with extension to adjacent organs. The radical resection includes a radical lymphadenectomy (D2 dissection). Its extent should be adapted to the individual situation by consideration at least of tumor site. Preferable is the use of a pretherapeutic computer model which calculates the probability of metastasis to the various lymph node groups considering additional factors with influence on lymphatic spread.

Objective: To investigate criteria for indication to surgery and results of laparoscopic fundoplication.

Background: Gastroesophageal reflux is a common problem in well developed countries. Beside clinical symptoms of heartburn and regurgitation complications may occur like esophagitis, bleeding, ulceration, mucosal metaplasia and loss of motility. A connection of reflux disease, Barrett's esophagus and adenocarcinoma of motility. A connection of reflux disease, Barrett's esophagus and adenocarcinoma of the esophagogastric junction is discussed. In some patients medical treatment is complicated by relapse, persistent or progressive disease. For these patients laparoscopic antireflux surgery may be an effective alternative.

Patients: 22 patients with chronic gastroesophageal reflux disease.

Methods: Since 9-2-1922 patients with gastroesophageal reflux disease were prospectively evaluated and treated by laparoscopic Nissen fundoplication.

Results: 11 patients had frequent recurrent disease, 9 persistent reflux and 2 a stricture while on medical treatment. All had pathologic reflux on 24 hour pH monitoring and defective sphincter on standard manometry. Beside an intraoperative pneumothorax there was no intraoperative complication. Postoperative 2 patients had a temporary and 1 mild persisted dysphagia. None had recurrent reflux. 10 patients were reevaluated one year after surgery. None had an esophagitis, abnormal reflux or an insufficient or hypercontinent sphincter.

Conclusions: Patients with recurrent or persistent reflux while on medical treatment with abnormal reflux on pH monitoring and defective sphincter on manometry can be treated by laparoscopic Nissen fundoplication with good results.

In 23 chronic alcoholics and 23 controls gastric emptying, antral motility, fasting gallbladder volume and gallbladder emptying after a standardized, liquid fatty meal were investigated ultrasonically in order to assess the effect of chronic alcoholism on postprandial gastrobiliary motility. Only a subgroup of the alcoholics with signs of autonomic cardiovascular neuropathy (21.7%) exhibited a significant antral hypomotility and a tendency towards higher fasting gallbladder volumes. No significant differences between the study groups could be obtained for the other parameters. The duration and daily amounts of alcohol consumption were not significant different between patients with autonomic neuropathy and patients without autonomic neuropathy. Within the whole group of alcohol consumers the only significant correlation that was observed occurred between the fat induced gallbladder residual volumes and the amounts of daily alcohol consumption (r = 0.62, p < 0.05). However 19 of these 23 relative gallbladder residual volumes were within the normal range (95. percentile of the control group), indicating no major clinical relevance of this phenomenon. None of the motility parameters exhibited a significant correlation to the duration of alcohol consumption. From these results chronic alcohol consumption has no irreversible effects of clinical relevance on the postprandial gastrobiliary motility in the majority of patients in contrast to well documented reversible effects of acute alcohol consumption on gastric motility.

A 35-year old woman showed gastrointestinal bleeding right after normal pregnancy. With endoscopy of the GI-tract with biopsy, ultrasound, conventional radiology of the stomach and computed tomography a gastric leiomyoma was diagnosed. After en-bloc resection of tumor, part of the stomach and spleen, histologic examination and size of tumor changed diagnosis in gastric leiomyosarcoma. Patient died 15 month postoperatively on systemic metastasis. Case report and review of the literature show difficulties in diagnosis and prognosis of gastric leiomyosarcoma.

Objective: To investigate the surgical results of adenocarcinoma of the esophagus and esophagogastric junction and its relationship with gastroesophageal reflux disease (GERD) and Barrett's esophagus.

Background: The incidence of adenocarcinoma of the cardia is continuously rising. Specialized intestinal metaplasia in Barrett's esophagus seems to be the source of these tumors. Barrett's esophagus is end stage GERD. In experimental studies alkaline reflux give rise of Barrett's esophagus and adenocarcinoma.

Patients: 122 patients with adenocarcinoma of the cardia and 121 patients with squamous cell tumor of the esophagus.

Methods: All esophageal resections between 11/85 and 2/95 were retrospectively analyzed. The relationship of gastroesophageal reflux disease, Barrett's esophagus and malignancy was compared between both groups using parameters of case history and histological sections. Survival was analyzed for tumorstage, T-and N-stage and R-classification.

Results: 5.9% of the adenocarcinomas were stage I, 44.1% stage II, 41. 5% stage III and 8.5% stage IV. Heartburn, regurgitation, consumption of H2 blockers or Barrett's mucosa were significantly more frequent for adenocarcinomas. A 5 year survival of 100% was seen for stage I tumors. Invasion of t he muscular layer reduced survival to 50%, lymph node invasion to 20%. R0-resection had a survival of 40%.

Conclusions: A relationship of GERD and adenocarcinoma of the cardia seems to be likely in our cases. Most patients had advanced malignancy. Survival is good only for early cases. Prevention of tumor genesis with effective antireflux surgery in case of alkaline reflux seem to be the best therapeutic decision.

1026 patients of more than 65 of age who underwent abdominal surgical treatment were retrospectively investigated with respect to pre-operative riskfactors, post-operative complications and mortality. Mortality after emergency intervention was with 16.54% about 3 times as high as after elective surgery (5.54%). 25.4% of all patients had no coexisting diseases. Preexisting diseases were cardiovascular (45.9%), hypertension (28.7%), pulmonary diseases (19.4%) and diabetes mellitus (16.6%). 37.32% of all patients showed one accompanying disease, 23.98% two, 10.4% three and 4 or more were described with 3.31%. The average number of riskfactors was 1.1 for patients aged 65-69 years, 1.34 for patients aged 70-74 years, 1.52 for those aged 75-79 years and 1.41 for patients over 80 years. There was a significant increase of mortality with rising numbers of riskfactors (p < 0.01). In 50.58% of all patients no post-operative complications developed. Cardiovascular, pulmonary and myocardial complications were the leading complications, occuring in 18.52%, 16.8% and 13.74% of patients, being followed by cerebral-vascular (5.63%) and renal (4.09%) complications. The incidence of medical complications was significantly higher after emergency than after elective surgery (p < 0.01). At least 4 and more complications occurred after 2.56% of elective interventions but after 20.24% of emergency surgery. A significant increase of postoperative complications has been observed with increasing extent of anaesthesia (p < 0.01). Moreover, the incidence of complications increased significantly with the amount of preoperative coexisting diseases (p < 0.01).

Chronic diarrhea, defined by frequent bowel movements with decreased stool consistency lasting for longer than 3 weeks represents a major problem in gastroenterology. In addition to the very frequent functional disturbances of irritable bowel syndrome a wide variety of infectious, drug-induced, alimentary, metabolic, hormonal and organic causes requires a thorough evaluation of this symptom. To reach diagnosis an algorithm applying a wide array of diagnostic procedures based on the results of thorough anamnesis, physical examination and stool visit should be followed. In addition to alleviation of symptoms, reconstitution and prevention of nutrional deficits (volume, electrolytes, trace elements, vitamines, calories) therapeutic approaches should eliminate underlying causes whenever possible. Symptomatic relief is provided by substances inhibiting secretion and motility as the opiatagonist Loperamid or anticholinergics. Substitution of vitamins, trace elements, calories, enzymes or bile salts should be adapted to the individual needs. Elimination of a cause of chronic diarrhea is generally provided be anti-infectious therapy, other causes however (e.g. sprue by the elimination of gliadin from diet) may be treated effectively as well.

Report of 8 cases of sebaceous glands in the esophagus diagnosed by endoscopy and review of the literature.