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Galetin T, Galetin A, Vestweber KH, Rink AD. Systematic review and comparison of national and international guidelines on diverticular disease. Int J Colorectal Dis 2018; 33:261-272. [PMID: 29349481 DOI: 10.1007/s00384-017-2960-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Diverticular disease is common and of increasing medical and economical importance. Various practice guidelines on diagnostic and treatment on this disease exist. We compared current guidelines on the disease in order to identify concordant and discordant recommendations. METHOD Eleven national and international guidelines on diverticular disease published over the last 10 years have been identified by a systematic literature review on PubMed and compared in detail for 20 main and 51 subtopics. RESULTS The available evidence for the most aspects was rated as moderate or low. There was concordance for the following items: Diagnosis of diverticulitis should be confirmed by imaging methods (10 of 10 guidelines). Mild forms may be treated out-patient (10/10). Abscesses are treated non-surgically (9/9). Elective surgery should be indicated by individual patient-related factors, only, and be performed laparoscopically (10/10, 9/9 respectively). Main differences were found in the questions of appropriate classification, imaging diagnostic (computed-tomography versus ultra-sound), need for antibiotics in out-patient treatment and mode of surgery for diverticular perforation. Despite growing evidence that antibiotics are not needed for treating mild diverticulitis, only 3/10 guidelines have corresponding recommendations. Hartmann's procedure has been abandoned several years ago and is now recommended for feculent peritonitis by the three most recent guidelines. In contrast, laparoscopic lavage without resection is not recommended anymore. CONCLUSION There are dissents in the recommendations for central aspects regarding the diagnostic and treatment of diverticular disease in recently published guidelines.
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Affiliation(s)
- T Galetin
- Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
| | - A Galetin
- Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany
| | - K-H Vestweber
- Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany
| | - A D Rink
- Department of General, Visceral and Thoracic Surgery, Leverkusen General Hospital, Am Gesundheitspark 11, 51375, Leverkusen, Germany.
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Weiss H, Zorron R, Vestweber KH, Vestweber B, Boni L, Brunner W, Sietses C, Morales Conde S, Bulut O, Gash K, Dixon AR, Mittermair C, Klaus A, Stanger O, Weiss M, Muratore A, Hell T. ECSPECT prospective multicentre registry for single-port laparoscopic colorectal procedures. Br J Surg 2016; 104:128-137. [PMID: 27762435 DOI: 10.1002/bjs.10315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The international multicentre registry ECSPECT (European Consensus of Single Port Expertise in Colorectal Treatment) was established to evaluate the general feasibility and safety of single-port colorectal surgery with regard to preoperative risk assessment. METHODS Consecutive patients undergoing single-port colorectal surgery were enrolled from 11 European centres between March 2010 and March 2014. Data were analysed to assess patient-, technique- and procedure-dependent parameters. A validated sex-adjusted risk chart was developed for prediction of single-port colorectal surgery-related conversion and complications. RESULTS Some 1769 patients were enrolled, 937 with benign and 832 with malignant conditions. Procedures were completed without additional trocars in 1628 patients (92·0 per cent). Conversion to open surgery was required in 75 patients (4·2 per cent) and was related to male sex and ASA fitness grade exceeding I. Conversions were more frequent in pelvic procedures involving the rectum compared with abdominal procedures (8·1 versus 3·2 per cent; odds ratio 2·69, P < 0·001). Postoperative complications were observed in a total of 224 patients (12·7 per cent). Independent predictors of complications included male sex (P < 0·001), higher ASA grade (P = 0·006) and rectal procedures (P = 0·002). The overall 30-day mortality rate was 0·5 per cent (8 of 1769 patients); three deaths (0·2 per cent; 1 blood loss, 2 leaks) were attributable to surgical causes. CONCLUSION The feasibility and safety, conversion and complication profile demonstrated here provides guidance for patient selection.
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Affiliation(s)
- H Weiss
- Department of Surgery, Saint John of God Hospital (Paracelsus Medizinische Universität - Teaching Hospital) Salzburg
| | - R Zorron
- Department of Innovative Surgery, Klinikum Bremerhaven Reinkenheide, Bremerhaven, Germany
| | - K-H Vestweber
- Department of General, Visceral and Thoracic Surgery, Klinikum Leverkusen, Leverkusen, Germany
| | - B Vestweber
- Department of General, Visceral and Thoracic Surgery, Klinikum Leverkusen, Leverkusen, Germany
| | - L Boni
- Minimally Invasive Surgery Research Centre, University of Insubria, Varese, Italy
| | - W Brunner
- Department of Surgery, Klinikum für Chirurgie Rorschach, St Gallen, Switzerland
| | - C Sietses
- Department of Surgery, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - S Morales Conde
- Department of Surgery, Unit of Surgical Innovation in Minimally Invasive Surgery, University Hospital 'Virgen del Rocio', Seville, Spain
| | - O Bulut
- Department of Surgical Gastroenterology, Hvidovre University Hospital, Copenhagen, Denmark
| | - K Gash
- North Bristol NHS Trust, Bristol, UK
| | - A R Dixon
- North Bristol NHS Trust, Bristol, UK
| | - C Mittermair
- Department of Surgery, Saint John of God Hospital (Paracelsus Medizinische Universität - Teaching Hospital) Salzburg
| | - A Klaus
- Department of Surgery, Sisters of Mercy Hospital, Vienna, Austria
| | - O Stanger
- Department of Surgery, Saint John of God Hospital (Paracelsus Medizinische Universität - Teaching Hospital) Salzburg
| | - M Weiss
- Department of Surgery, Saint John of God Hospital (Paracelsus Medizinische Universität - Teaching Hospital) Salzburg
| | - A Muratore
- Unit of Surgical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Turin, Italy
| | - T Hell
- Department of Mathematics, University of Innsbruck, Innsbruck, Austria
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Rink AD, Vestweber B, Paul C, Vestweber KH. Lymph node harvest in single incision laparoscopic surgery for colorectal malignancy. Colorectal Dis 2014; 16:265-70. [PMID: 24325148 DOI: 10.1111/codi.12517] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 10/02/2013] [Indexed: 02/08/2023]
Abstract
AIM Single incision laparoscopic surgery (SILS) has not been sufficiently evaluated with respect to its oncological equivalence to conventional laparoscopic or open surgery. METHOD Of 507 patients who had SILS for colorectal diseases in our institution, 87 had segmental resection for colorectal adenocarcinoma. For each of the surgical specimens the number of lymph nodes which can be expected to be identified by the pathologist was calculated using the ACPGBI lymph node harvest model, which was developed from a nationwide database of 5845 surgical specimens. The predicted number of lymph nodes was compared with the number identified in our SILS specimens. RESULTS The median predicted number of lymph nodes was 11 (4.5-14.8) compared with 18 (5-44) in the SILS specimens (P < 0.001). In all subgroups analysed for various operations, the lymph node harvest in the SILS specimens was significantly higher than predicted. CONCLUSION In terms of lymph node harvest SILS seems to be comparable to conventional open or laparoscopic surgery.
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Affiliation(s)
- A D Rink
- Department of General Surgery, Leverkusen General Hospital, Leverkusen, Germany
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Vestweber B, Straub E, Haaf F, Vestweber KH. Der schwierige Situs bei Divertikulitis – wo liegen die Grenzen der laparoskopischen Colonchirurgie? Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1288977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lammerting K, Kaldowski B, Straub E, Vestweber B, Vestweber KH. Single Incision Laparoscopic Surgery (SILS™) Proctocolektomie bei Colitis Ulcerosa – eine mögliche Operationsmethode? Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1288997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Galetin T, Kaldowski B, Giehl J, Vestweber B, Vestweber KH. Single Incision Laparoscopic Surgery SILS™ abdomino perineale Rektumexstirpation – eine Möglichkeit zur Reduktion des abdominellen Zugangstraumas? Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1288996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Kaldowski B, Lelli A, Giehl J, Vestweber B, Vestweber KH. Single Port transanale Tumorresektion (SPTTR) – eine gute alternative zur TEM? Zentralbl Chir 2011. [DOI: 10.1055/s-0031-1288998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Rink AD, Kneist W, Radinski I, Guinot-Barona A, Lang H, Vestweber KH. Differences in ano-neorectal physiology of ileoanal and coloanal reconstructions for restorative proctectomy. Colorectal Dis 2010; 12:342-50. [PMID: 19207698 DOI: 10.1111/j.1463-1318.2009.01790.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Restorative proctectomy with straight coloanal anastomosis (CAA) and restorative proctocolectomy with ilealpouch-anal anastomosis (IPAA) are options for maintaining bowel integrity after rectal resection. The aim of this study was to compare clinical function and anorectal physiology in patients treated with CAA and IPAA. METHOD Three-dimensional vector-manometry and neorectal volumetry were performed in straight CAA [53 patients (34 male)] and IPAA [61 patients (39 male)] for ulcerative colitis. Function was assessed using a 14 day incontinence diary. RESULTS Function was similar in both groups, but neorectal compliance and threshold volumes for sensation, urge and maximum tolerated volume (MTV) were significantly higher after IPAA than after CAA. Mean pressure, vector volume and sphincter symmetry at rest were significant determinants of continence in both groups but squeeze pressure did not correlate significantly with function in either group. Threshold volume, MTV, and compliance were significantly correlated with frequency of defecation in patients with IPAA but not with CAA. CONCLUSION A strong consistent resting anal sphincter pressure is one determinant of continence after both IPAA and CAA. Squeeze pressures do not influence the functional result. In IPAA but not CAA, the neorectum has a reservoir function which correlates with the postoperative frequency of defaecation.
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Affiliation(s)
- A D Rink
- Leverkusen General Hospital, Department of General Surgery, Am Gesundheitspark, Leverkusen, Germany.
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Rink AD, John-Enzenauer K, Haaf F, Straub E, Nagelschmidt M, Vestweber KH. Laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy for diverticular disease? A prospective randomized trial on postoperative pain and analgesic consumption. Dis Colon Rectum 2009; 52:1738-45. [PMID: 19966607 DOI: 10.1007/dcr.0b013e3181b552cf] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Laparoscopic-assisted sigmoidectomy is an attractive but sometimes challenging operative technique for the treatment of diverticulitis of the sigmoid colon. The aim of this study was to compare, with respect to early postoperative analgesic demand and postoperative pain, laparoscopic-assisted sigmoidectomy with a laparoscopic-facilitated technique. In the laparascopic-facilitated technique, the sigmoid colon is removed conventionally via a cosmetically inconspicuous incision after prior laparoscopic mobilization. PATIENTS AND METHODS Patients subjected to elective sigmoidectomy for diverticulitis were randomized to either laparoscopic-assisted or laparoscopic-facilitated sigmoidectomy. All patients had piritramide-based, patient-controlled analgesia. The cumulative postoperative consumption over 96 hours was defined as the primary end point. Postoperative pain, fatigue, pulmonary function, and resumption of bowel function were secondary endpoints. RESULTS : Forty-five patients were randomized according to the protocol to laparoscopic-assisted sigmoidectomy (n = 22) or laparoscopic-facilitated sigmoidectomy (n = 23). The analgesic consumption between the two groups was equivalent (61.3 (9-171) mg piritramide/96 hours vs. 64.3 (18-150) mg piritramide/96 hours; P = 0.827). Patients with laparoscopic-assisted sigmoidectomy had lower pain levels on Day one and Day two. Cumulative pain levels over 96 hours and over the whole 7-day observation period, however, were not significantly different, although postoperative fatigue and pulmonary function were significantly different. Duration of surgery was slightly shorter for laparoscopic-assisted sigmoidectomy (127 (47-200) vs. 135 (60-239) minutes; P = 0.28), but recovery of bowel activity was faster after laparoscopic-facilitated surgery. There was no significant difference in morbidity. CONCLUSION Overall, the postoperative outcome was roughly equivalent after both techniques of laparoscopic sigmoidectomy. Therefore, laparoscopic-facilitated sigmoidectomy could be considered as an alternative to laparoscopic-assisted sigmoidectomy in technically difficult cases of diverticulitis subjected to laparoscopic surgery.
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Affiliation(s)
- Andreas D Rink
- Leverkusen General Hospital, Department of General Surgery, Leverkusen, Germany.
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Rink AD, Haaf F, Knupper N, Vestweber KH. Prospective randomised trial comparing ileocaecal interposition and colon-J-pouch as rectal replacement after total mesorectal excision. Int J Colorectal Dis 2007; 22:153-60. [PMID: 16625377 DOI: 10.1007/s00384-006-0122-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ileocaecal interposition (ICI) is a technique of rectal replacement after total mesorectal excision (TME), but the method has never been evaluated in a randomised fashion. We performed a randomised, controlled trial to compare ICI and colon-J-pouch (CJP) for rectal replacements after TME for rectal cancer. MATERIALS AND METHODS Fifteen patients were enrolled into each treatment group of the trial according to the protocol. Follow-up evaluations were performed 3 months and 1 year after ileostomy closure and at a mean of 5 years after initial surgery. RESULTS Similar results between the groups were found for incontinence, urgency, constipation and quality of life at all follow-ups. The frequency of defecation was slightly lower in the CJP group at 3 months [3 (2-6) vs 5 (2-11) (p=0.043)] and at 1 year [3 (2-5) vs 5 (2-8) (p=0.034)]. However, this difference lost significance if patients who had postoperative radiotherapy were excluded from the analysis. Four out of the 15 patients treated with ICI experienced bowel obstruction, which required open surgery in two, endoscopic dilatation in one or maintenance of the ileostomy in one patient. None of the patients treated with CJP had similar complications. CONCLUSIONS ICI and CJP reconstruction result in a similar functional outcome and quality of life. As ICI did not show any benefit over CJP and tended to result in a higher frequency of defecation, it should not be used as a first choice treatment. In addition, ICI was associated with significant complications after radiotherapy. Therefore, it must not be used if postoperative radiochemotheray is intended.
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Affiliation(s)
- A D Rink
- Department of General Surgery, Leverkusen General Hospital, Dhünnberg 60, 51375 Leverkusen, Germany.
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Knupper N, Straub E, Terpe HJ, Vestweber KH. Adenocarcinoma of the ileoanal pouch for ulcerative colitis--a complication of severe chronic atrophic pouchitis? Int J Colorectal Dis 2006; 21:478-82. [PMID: 16365680 DOI: 10.1007/s00384-005-0063-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2005] [Indexed: 02/04/2023]
Abstract
BACKGROUND The appearance of a carcinoma in the ileal pouch after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative proctocolitis is rare. Most of these adenocarcinomas previously described in literature develop from residual viable rectal mucosa. We report a case of an adenocarcinoma arising in all probability from the ileal pouch after malignant transformation of the ileal pouch mucosa based on a chronic atrophic pouchitis. PATIENT AND METHODS A 34-year-old man developed an adenocarcinoma after a double-stapled ileorectal J-pouch for ulcerative colitis (UC) proceeded from malignant ileal transformation. Before surgery, he had a 20-year history of UC refractory to medical therapy, but no occurrence of backwash ileitis, dysplasia or colitis-associated illness. He experienced severe pouchitis after IPAA since the ileostomy closure. Carcinoma was ensured by endoscopy, and the patient underwent an abdominoperineal pouch extirpation combined with excision of perirectal tissues and anal canal. Histology after surgery showed a pT4,pN2(4/16)pM0,G3 adenocarcinoma with global severe chronic atrophic pouchitis (CAP), villous atrophy and malignant ileal transformation. No metaplasia of the rectal mucosa was found, not even malignant epithelial transformation of the anal canal. CONCLUSION This case suggests that a malignant transformation of the ileal pouch mucosa may occur as a pure complication of severe CAP, even in the absence of backwash ileitis or a previous history of cancer. The absence of metaplasia of the rectal mucosa revealed the passage from CAP to dysplastic epithelium and to cancer. A multifactorial development of carcinogenesis is supposed, but we emphasize the importance of severe CAP, and that careful surveillance is needed in patients after IPAA. We must submit that this is just a case report and cannot stand for general cancer development in ulcerative colitis, but it may point out the risk factor of chronic inflammation and leads the surgeon to skillful working when building the pouch.
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Affiliation(s)
- N Knupper
- Department of Surgery, Colorectal Unit, Klinikum Leverkusen, NRW, Germany.
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Stass H, Rink AD, Delesen H, Kubitza D, Vestweber KH. Pharmacokinetics and peritoneal penetration of moxifloxacin in peritonitis. J Antimicrob Chemother 2006; 58:693-6. [PMID: 16895940 DOI: 10.1093/jac/dkl305] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the penetration of moxifloxacin into peritoneal exudate in patients with complicated intra-abdominal infections (cIAIs). PATIENTS AND METHODS Patients (n = 10) with evidence of peritonitis who required surgery with drainage of the abdominal cavity received a single intravenous infusion of moxifloxacin, 400 mg, over 1 h. Plasma and peritoneal exudate samples were obtained over 24 h, and moxifloxacin concentrations were measured by HPLC with fluorescence detection. RESULTS Plasma moxifloxacin concentrations decreased from a geometric mean of 3.61 mg/L at 1 h to 0.36 mg/L at 24 h. Concentrations in peritoneal exudate were highest 2 h after the start of the infusion, reaching a geometric mean of 3.32 mg/L, and declined to a geometric mean of 0.69 mg/L at 24 h. The exudate/plasma concentration ratio rose from 1.45 at 2 h to 1.91 at 24 h; the 95% confidence intervals for the ratio excluded unity at all time points, suggesting that moxifloxacin penetrates and accumulates in peritoneal exudate. The area under the concentration-time curve (AUC) tended to be greater in exudate; the time to peak concentrations (T(max)) was longer in exudate than in plasma, as were half-life and mean residence time (MRT). CONCLUSIONS Following intravenous administration, moxifloxacin penetrated peritoneal exudate in patients with peritonitis, achieving and maintaining concentrations that exceed the MICs for pathogens commonly isolated in cIAIs. These findings support the clinical use of moxifloxacin as treatment for cIAIs.
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Affiliation(s)
- H Stass
- Pharma Research Centre Bayer AG, Wuppertal, Germany.
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Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, Jauch KW, Kemen M, Hiesmayr JM, Horbach T, Kuse ER, Vestweber KH. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr 2006; 25:224-44. [PMID: 16698152 DOI: 10.1016/j.clnu.2006.01.015] [Citation(s) in RCA: 639] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Accepted: 01/20/2006] [Indexed: 02/07/2023]
Abstract
Enhanced recovery of patients after surgery ("ERAS") has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include: Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in surgical patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1980. The guideline was discussed and accepted in a consensus conference. EN is indicated even in patients without obvious undernutrition, if it is anticipated that the patient will be unable to eat for more than 7 days perioperatively. It is also indicated in patients who cannot maintain oral intake above 60% of recommended intake for more than 10 days. In these situations nutritional support should be initiated without delay. Delay of surgery for preoperative EN is recommended for patients at severe nutritional risk, defined by the presence of at least one of the following criteria: weight loss >10-15% within 6 months, BMI<18.5 kg/m(2), Subjective Global Assessment Grade C, serum albumin <30 g/l (with no evidence of hepatic or renal dysfunction). Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.
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Affiliation(s)
- A Weimann
- Klinik f. Allgemein- und Visceralchirurgie, Klinikum "St. Georg", Leipzig, Germany.
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Rink AD, Liese M, Terpe HJ, Vestweber KH. [Contraction of the hip and fecal drainage via a fistula tract 30 years after "appendectomy"]. Chirurg 2004; 76:80-4. [PMID: 15551013 DOI: 10.1007/s00104-004-0937-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 46-year-old female was admitted with increasing fecal drainage via a fistula tract in the right inguinal region. She had a history of surgery for appendicitis 30 years previously, from which there was disturbed wound healing resulting in a blunt fistula, and the patient suffered from contraction of the right hip. Computed tomographic scan and ultrasound demonstrated an inflammatory mass in the right inguinal region. Colonoscopy demonstrated a stenosis of the rectosigmoid junction but did not provide any further specific information. Surgery revealed the presumed diagnosis of complicated Crohn's disease, but an advanced squamous cell carcinoma was also identified. The patient died 23 months later due to generalized tumor. Although malignant transformation of a fistula tract is rare, this case demonstrates that long-standing fistulas should be cured as far as possible without significant morbidity. In the case of incurable fistulas, malignancy must definitely be excluded if the clinical appearance of the fistula changes.
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Affiliation(s)
- A D Rink
- Abteilung für Allgemeinchirurgie, Klinikum Leverkusen.
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Vestweber KH. [Surgical approach is toxic colitis]. Kongressbd Dtsch Ges Chir Kongr 2003; 119:67-72. [PMID: 12704871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Toxic colitis is still a major diagnostic and therapeutic challenge. Mortality rates depend on the severity of the disease and range from 2% to 30%. Interdisciplinary approaches are necessary and structured therapeutic steps from conservative to operative treatment seem to be most effective. The surgical option for toxic colitis usually is subtotal colectomy with closure of the rectal stump or mucus fistula and ileostomy. This procedure allows the reconstructive operation later on. In selected cases and suitable situations a primary colectomy with ilealpouch are also possible depending on local and general effects.
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Lorenz M, Staib-Sebler E, Gog C, Proschek D, Jauch KW, Ridwelski K, Hohenberger W, Gassel HJ, Lehmann U, Vestweber KH, Padberg W, Zamzow K, Müller HH. Prospective pilot study of neoadjuvant chemotherapy with 5-fluorouracil, folinic acid and oxaliplatin in resectable liver metastases of colorectal cancer. Analysis of 42 neoadjuvant chemotherapies. Zentralbl Chir 2003; 128:87-94. [PMID: 12632273 DOI: 10.1055/s-2003-37760] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Since there are currently no data available from a prospective trial, the primary objective of this prospective study was to investigate whether the rate of R0-liver resections without morbidity would be at least 50 % in patients with neoadjuvant chemotherapy for colorectal liver metastases. PATIENTS AND METHODS 42 patients were treated with a biweekly FOLFOX regimen. Chemotherapy consisted of a 2-hour infusion of folinic acid (FOL) 500 mg/m2, followed by a 24-hour infusion of 5- fluorouracil (F) 2000 mg/m2 daily for two days. Oxaliplatin (OX) 85 mg/m 2 was given simultaneously with FOL. Treatment allocation was randomized with either 3 or 6 cycles for the final 30 patients. A liver resection was performed 2 to 5 weeks after the final infusion. RESULTS An objective response was observed in 20 of 42 patients (response rate was 27 % higher after 6 cycles). Liver resection (R0) could be performed in 34 patients. Postoperative complications were reported in 14 patients (13 occurring within 30 days after resection) and severe complications in 5 cases (including two deaths after extended resection). Liver failure and persistent biliary fistula were the most frequently documented complications. There was no relevant difference in safety criteria between 3 and 6 applications. CONCLUSION The use of neoadjuvant chemotherapy in resectable liver metastases induced significant remissions without increasing morbidity. The rate of severe complications and cases of no R0-resection in this study was 31 % and was with that significantly lower than 50 % (95 % CI 17.6 %-47.1 %). The risk to the patient is therefore acceptable when undergoing neoadjuvant treatment in a prospective intergroup trial.
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Affiliation(s)
- Matthias Lorenz
- Department of General and Vascular Surgery, Johann-Wolfgang-Goethe-University Frankfurt, Frankfurt au Main.
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Abstract
AIM The interposition of an ileocoecal segment has been introduced as an alternative procedure to impair the functional outcome following total mesorectal excision (TME). Up to now, there is no information concerning the effect of postoperative radiotherapy on the functional outcome of this method. PATIENTS AND METHODS We compared functional outcome, anorectal physiology, and radiation therapy-related morbidity of 18 patients treated with TME und ileocoecal interposition (ICI) of which ten had postoperative radiotherapy, with 15 patients who had TME and colonic J-pouch (CJP) reconstruction of which 7 were subjected to radiotherapy. RESULTS Patients with no radiotherapy revealed a satisfying functional result with a similar median frequency of defecation of 4.25 (2-5) and 3 (2-6) and an incontinence-score of 2.8 (0-6) and 1.0 (0-2) after ICI and CJP, respectively. Median stool frequency (7 (2-11) (ICI) and 5 (2.5-11) (CJP)) and incontinence score (6 (0-12) (ICI) and 7 (6-12) (CJP)) were markedly increased in both groups after radiotherapy. Besides a reduced anal resting pressure, a lower compliance and a smaller volume of the neorectum were observed in the irradiated patients. A radiogenic injury which required surgery was seen in 4/10 patients after ICI. In three of these four patients the interposed ileocoecal segment was mainly affected. None of the patients treated with a CJP suffered a similar complication. DISCUSSION These data indicate that postoperative radiotherapy severely impairs the functional outcome after TME independent of the type of surgery used for reconstruction, and causes a significant morbidity after ICI. CONCLUSION Postoperative radiotherapy following TME should be indicated cautiously, and ICI should not be used if postoperative radiotherapy is intended.
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Affiliation(s)
- A D Rink
- Klinikum Leverkusen, Abteilung für Allgemeinchirurgie
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18
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Rink AD, Goldschmidt D, Dietrich J, Nagelschmidt M, Vestweber KH. Negative side-effects of retention sutures for abdominal wound closure. A prospective randomised study. Eur J Surg 2000; 166:932-7. [PMID: 11152253 DOI: 10.1080/110241500447083] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To assess the effect of retention sutures on the postoperative course of patients after major abdominal operations. DESIGN Prospective, randomised study. SETTING Teaching hospital, Germany. SUBJECTS 95 patients who were at increased risk of wound failure after major abdominal operations. INTERVENTION Conventional mass closure either with (n = 44) or without (n = 51) reinforcement by wire retention sutures. MAIN OUTCOME MEASURES Pain intensity on postoperative days 3, 6, 9, and 12, patients' acceptance, retention-suture-related morbidity, general morbidity. RESULTS Postoperative pain was overall more severe with retention sutures. On day 6, 31/49 control patients but only 13/41 patients with retention sutures were pain-free (p = 0.003, 95% CI 0.12 to 0.51). Twelve of 44 patients with retention sutures developed local complications of the sutures, and 21 of the 44 had to have them removed prematurely, in most cases because of intolerable pain. CONCLUSIONS Retention sutures used to close abdominal wounds cause inconvenience, pain, and specific morbidity.
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Affiliation(s)
- A D Rink
- Department of General Surgery, Leverkusen General Hospital, Germany
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19
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Abstract
Decreasing financial resources in health services often lead to wholesale budget reducing in hospitals. Enterostomal therapists are more and more concerned by this situation. Data on the cost-effectiveness of stoma therapy have not existed, a gap filled by the present study. From January to December 1996 data from 94 patients about therapy-related costs, outcome, and evaluation of stoma therapy from the patient's point of view were ascertained prospectively. For an average (SD) of 14.6 (7.1) patient contacts for stoma planning, advice, care, and so on the average duration was 12.9 (9.1) minutes per contact. At an average exchange rate of 1.50 German marks (DM) per US dollar in 1996 the enterostomal therapist's part of the total staff costs was US$15,212 (2.7%), the cost of stoma products was US$7750 (4.5% of the total costs of medical supplies). About 89.3% of the patients classified the enterostomal therapist necessary and indispensable; 70.3% of the patients said they could cope with their stoma very well to well at the time of questioning. In contrast, 69.2% of those questioned declared that without the care by the enterostomal therapist in hospital they would be able to cope with their stoma only poorly to very poorly. We conclude that from the patient's point of view the costs of our stoma therapy are justifiably low. Therefore we see no reason for a discussion about rationalization measures regarding our stoma therapy staff.
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Affiliation(s)
- A Becker
- Department of Medical Controlling, Klinikum Leverkusen gGmbH, Academic Hospital of the University of Cologne, Dhünnberg 60, D-51375 Leverkusen, Germany
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20
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Dietrich J, Vestweber KH. [Problems in calculating and recalculating case fees and special reimbursements exemplified by a general surgery clinic]. Langenbecks Arch Chir Suppl Kongressbd 1998; 114:791-3. [PMID: 9574270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A calculation of costs for the not perforated appendicitis was performed. The main costs are the nursing costs on ward. As one of the consequences we have to prove the intensity of nursing and the resulting classification to reduce the depending more costs of 200 DM.
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Affiliation(s)
- J Dietrich
- Interne Qualitätssicherung, Klinikum Leverkusen gGmbH
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21
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Vestweber KH, Lepique F, Haaf F, Horatz M, Rink A. [Mesh-plasty for recurrent abdominal wall hernias--results]. Zentralbl Chir 1998; 122:885-8. [PMID: 9446451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The rates of re-recurrent hernias after initial abdominal wall hernia repair are high. To reduce this intolerable high recurrence rate, 31 patients were treated by polypropylene-mesh implantation and followed up for about 3 years. Two new hernias could be diagnosed and were treated without problems by repeated implantation of Prolene-mesh. About 50% of patients complain of some pain at the edges of the implanted mesh--usually this makes only very few discomfort for the patients. The Polypropylene (Prolene) mesh implantation seems to reduce re-recurrence rates compared to published results of hernia repair without mesh implantation.
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22
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Viell B, Krause B, Vestweber KH, Schaaf S, Scholl H. Transintestinal elimination of ciprofloxacin in humans--concomitant assessment of its metabolites in serum, ileum and colon. Infection 1992; 20:324-7. [PMID: 1293050 DOI: 10.1007/bf01710676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ciprofloxacin (200 mg) was infused to seven patients at the beginning of elective colorectal surgery. Thirty minutes after the end of infusion (i.e. 60 min after the start of the operation) ciprofloxacin reached concentrations of 1.60 mg/l in serum and of 3.42-6.07 mg/kg fresh weight in the ileum and colon. During the next 30 min (90 min after the start of operation) the concentration of ciprofloxacin in serum decreased to 86% of its initial level, but this decrease was less rapid than that observed in the ileal (to 56.8%) or colonic (to 74.8%) mucosa. Three metabolites could be identified (desethylen-, sulpho-, oxociprofloxacin). Initially, at 60 min the amount of these metabolites was about 15% of the total drug concentration in serum, but only 2-3% of that in the gut tissues. At 90 min the relative amount of metabolites was increased in serum as well as in the gut tissues. It is concluded that transintestinal elimination of ciprofloxacin is a general feature of the whole gut. Obviously, the elimination process is not due to degradation of ciprofloxacin within the gut wall.
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Affiliation(s)
- B Viell
- Chirurgischer Lehrstuhl, Universität Köln, Germany
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23
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Abstract
An 81-year-old woman underwent a colonoscopy because of a sigmoiditis poorly responding to conservative therapy. A rod-shaped foreign body found in the sigma proved impossible to remove conventionally. Irradiation with a low laser energy caused the foreign body to break apart, after which its extraction was straightforward. The further clinical course was uncomplicated. In this case a partial sigmoidectomy would have been indicated had the laser-supported extraction not been successful. The authors suggest that a similar procedure could be helpful in the management of foreign bodies in the esophagus.
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Affiliation(s)
- M Kaltheuner
- Medizinische Klinik II, Städtisches Krankenhaus Leverkusen, Federal Republic of Germany
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24
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Malchow H, Weidmann B, Uhrberg G, Vestweber KH, Troidl H. [Postoperative recurrence of Crohn disease]. Z Gastroenterol Verh 1991; 26:96-7. [PMID: 1714218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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25
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Abstract
Two techniques for preparation of the colon for colonoscopy were compared in a controlled trial. Fifty patients given a low residue diet and the laxative Prepacol were compared with 50 patients given whole gut irrigation. Significantly more patients suffered from vomiting (P = 0.0005), shivering (P = 0.0062) and nausea (P = 0.031) following irrigation; in two cases the procedure had to be abandoned because of profuse vomiting. Irrigation was less well tolerated by the patients (P = 0.00002) than preparation with Prepacol. On the other hand, the quality of bowel preparation was found to be better (P = 0.0005) after irrigation. On two occasions colonoscopy was not possible following Prepacol preparation because of faecal residue. Patients with a previous colorectal resection showed a similar quality of cleansing to those patients prepared with irrigation. We conclude that Prepacol is as efficient as irrigation for patients who have had a previous colorectal resection because the quality of bowel preparation is as good and the associated patient discomfort is small.
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Affiliation(s)
- L Köhler
- II. Department of Surgery, University of Cologne, FRG
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26
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Viell B, Kill H, Vestweber KH, Rosier H. Human muscle tissue obtained intraoperatively from surgical patients--a tool for the assessment of biochemical body composition? Infusionstherapie 1990; 17 Suppl 3:35-8. [PMID: 1698183 DOI: 10.1159/000222549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- B Viell
- II. Chirurgischer Lehrstuhl, Universität zu Köln, FRG
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27
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Marelli D, Paul A, Manolidis S, Walsh G, Odim JN, Burdon TA, Shennib H, Vestweber KH, Fleiszer DM, Mulder DS. Endoscopic guided percutaneous tracheostomy: early results of a consecutive trial. J Trauma 1990; 30:433-5. [PMID: 2325175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Percutaneous tracheostomy is increasingly being used for patients needing prolonged ventilatory support. The purpose of this study was to assess the feasibility of widespread application of endoscopic guided percutaneous tracheostomy. Sixty-one consecutive ICU patients requiring prolonged mechanical ventilation underwent bedside endoscopic guided percutaneous tracheostomy. Using a modified Ciaglia technique, a #6-10 tracheostomy tube was introduced between the second and third tracheal rings. Bronchoscopic transillumination facilitated identification of the appropriate tracheostomy site, and verified satisfactory placement of dilators and tracheostomy tube. There was one procedure-related death due to arrhythmia. Procedure-related complications included (n = 7): bleeding (controlled with local pressure), two infections, two cuff tears, and two obstructions of the tracheal tube. The tracheostomy was eventually removed in 13 patients. Bronchoscopic evaluation of three patients at 4 months post-tracheostomy removal was normal and there has been no clinical evidence suggestive of tracheal stenosis in the remaining ten extubated patients. There was a 50% reduction in cost when compared to operative tracheostomy. Percutaneous tracheostomy is a simple, safe, cost-effective bedside procedure for critically ill ventilator-dependent patients. Endoscopic guidance appears to increase the safety of this procedure and may prevent complications of pneumothorax, subcutaneous emphysema, and paratracheal false passage previously reported with blinded percutaneous methods.
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Affiliation(s)
- D Marelli
- McGill University, Montreal General Hospital Critical Care & Trauma Unit, Canada
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28
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Vestweber KH, Troidl H. [Quality of life following stomach surgery]. Chirurg 1989; 60:450-3. [PMID: 2676409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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29
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Vestweber KH, Viell B, Schaaf S, Scholl H. Perioperative prophylaxis in colorectal surgery: is a single shot with 200 mg ciprofloxacin sufficient to maintain therapeutic levels in gut tissues? J Chemother 1989; 1:1012-3. [PMID: 16312748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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30
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Viell B, Vestweber KH, Scholl H, Schaaf S. A study of ciprofloxacin kinetics in human muscle and gut tissues. J Chemother 1989; 1:575-6. [PMID: 16312539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- B Viell
- II. Dept. Surgery, University of Cologne, FRG
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31
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Vestweber KH. [Optimizing technical administration forms]. Z Gastroenterol 1989; 27 Suppl 2:82-3. [PMID: 2514515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- K H Vestweber
- Chirurgische Klinik Köln-Merheim, II. Lehrstuhl für Chirurgie der Universität zu Köln
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32
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Vestweber KH, Eypasch E, Paul A, Bode C, Troidl H. [Fine-needle catheter jejunostomy]. Z Gastroenterol 1989; 27 Suppl 2:69-72. [PMID: 2514513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- K H Vestweber
- Chirurgische Klinik Köln-Merheim, II. Lehrstuhl für Chirurgie der Universität zu Köln
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33
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Vestweber KH, Viell B, Sommer H, Bode C, Paul A. [Technics for the administration of long-term enteral nutrition]. Krankenpfl J 1989; 27:26-32. [PMID: 2502654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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34
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Abstract
Bedside percutaneous tracheostomies are increasingly performed. This avoids patient transport to the operating room. Complications of this procedure are largely related to the blind nature of the technique. After laboratory studies, 4 patients underwent percutaneous endoscopic guided tracheostomy in a selective clinical trial. There were no procedure-related complications. Endoscopic guidance ensures precise low tracheostomy position, prevents paratracheal tube misplacement, and avoids inadvertent injuries.
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Affiliation(s)
- A Paul
- Department of Surgery, McGill University, Montreal, Quebec, Canada
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35
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Viell B, Vestweber KH, Krause B. Analysis of 5-OH-indoles in human gut biopsy tissues by reversed-phase high-performance liquid chromatography with fluorimetric detection. J Pharm Biomed Anal 1988; 6:939-44. [PMID: 16867365 DOI: 10.1016/0731-7085(88)80113-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/1987] [Revised: 11/03/1987] [Indexed: 11/20/2022]
Abstract
A method was devised for the rapid simultaneous determination of major indoles in human gut tissues. Analysis with picomol detection limits was done by HPLC on a C(18) reversed-phase column with fluorimetric detection at 276/350 nm. This simple method for which there is no necessity of derivatization or purification was validated for routine analysis of small mucosa samples (less than 4 mg fresh weight) obtainable during endoscopy. A comprehensive list of 5-OH-indole compounds in human gut tissue is presented.
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Affiliation(s)
- B Viell
- 2nd Department of Surgery, University of Cologne, Ostmerheimer Strasse 200, D-5000 Köln 91, FRG
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36
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Viell B, Weidler B, Krause B, Vestweber KH. Analysis of tryptophan, tyrosine and related dipeptides in mouse brain by isocratic high-performance liquid chromatography with switchable wavelength fluorescence detection. J Pharm Biomed Anal 1988; 6:933-8. [PMID: 16867364 DOI: 10.1016/0731-7085(88)80112-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/1987] [Revised: 11/03/1987] [Indexed: 10/18/2022]
Abstract
Tryptophan (Trp) and tyrosine (Tyr) are pharmacologically active compounds which, after administration of adequate doses, are increased in level in the brain, and stimulate neurotransmitter synthesis. Trp and Tyr containing dipeptides were tested as possible substitutes with regard to the effect on precursor level in the brain. Glycyltryptophan, alanyl-tryptophan and glycyl-tyrosine were intravenously applied to young female mice and the brain levels of dipeptides, Trp and Tyr measured 30 min after application. Neurotransmitter precursor levels in the brain increased similarly in all cases. The results suggest that the dipeptides are as effective as the single amino acids and may be superior because of their better solubility.
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Affiliation(s)
- B Viell
- 2nd Department of Surgery, University of Cologne, Ostmerheimer Strasse 200, D-5000 Köln 91, FRG
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37
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Troidl H, Kusche J, Vestweber KH, Eypasch E, Maul U. Pouch versus esophagojejunostomy after total gastrectomy: a randomized clinical trial. World J Surg 1987; 11:699-712. [PMID: 3324498 DOI: 10.1007/bf01656592] [Citation(s) in RCA: 107] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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38
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Vestweber KH, Troidl H, Sommer H, Viell B, Eypasch E, Paul A, Bode C. [Technics of percutaneous endoscopic gastrostomy]. Med Klin (Munich) 1987; 82:736-41. [PMID: 3119972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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39
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Abstract
Surgeons are increasingly using endoscopy to place transabdominal feeding tubes for enteral nutrition or gastric decompression. A possible extension for the application of this new technique is the direct placement of the feeding tube into the duodenal bulb. Two patients are presented in whom percutaneous endoscopic duodenostomy was successfully performed, although percutaneous endoscopic gastrostomy was not possible. It shows that this new method is technically possible. In both patients the positive influence of this technique on the patient's quality of life could be shown using the Spitzer Quality of Life Index and the Karnofsky Performance Status. Enteral nutrition was maintained for more than 6 weeks.
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Affiliation(s)
- A Paul
- Chirurgischer Lehrstuhl der Universität zu Köln, Federal Republic of Germany
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40
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Troidl H, Vestweber KH, Eypasch E. [Endoscopic therapeutic procedures on the esophagus and stomach (without hemorrhage)]. Chirurg 1987; 58:369-82. [PMID: 3111798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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41
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Troidl H, Kusche J, Vestweber KH, Eypasch E, Koeppen L, Bouillon B. Quality of life: an important endpoint both in surgical practice and research. J Chronic Dis 1987; 40:523-8. [PMID: 3298294 DOI: 10.1016/0021-9681(87)90009-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Surgery asks patients to trade present discomfort and risk for future gains. Although research reports on the effectiveness of surgery have largely focused on mortality, length of hospital stay, major complications, and laboratory analyses, the principal criteria guiding surgeons' clinical decisions and patients' acceptance of treatment are most often the patients' subjective feelings and capabilities, the quality of their lives. This is true for both major and minor surgical procedures. We discuss the role of information on functional capacity, overall well-being, and quality of life in the assessment of surgical outcomes. Broadening the choice of endpoints beyond traditional, so-called "hard" variables in surgical studies has advantages for both surgeons and patients.
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42
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Eypasch E, Troidl H, Sommer H, Vestweber KH. Long-term results of Troidl's technique of endoscopic pneumatic dilatation for achalasia of the esophagus. A prospective clinical trial. Surg Endosc 1987; 1:155-64. [PMID: 3332476 DOI: 10.1007/bf00590923] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In a prospective clinical trial, 26 consecutive patients underwent endoscopic pneumatic dilatation over a 10-year period. Dilatation was achieved by means of a balloon attached to a normal gastrointestinal fiberscope. With the endoscope in an inverse position, the device was placed in the cardia and the dilatation process was monitored macroscopically. Before dilatation, patients suffered from dysphagia (92%), reduced speed of swallowing (100%), symptom aggravation under stress (73%), weight loss (50%), aspiration, pain, regurgitation, and vomiting. After dilatation and long-term follow-up (mean of 5 years), symptoms could be markedly reduced, especially the speed of eating and symptom aggravation under stress. Excellent and good results (Visick scale) were achieved in 76%. Fair results were achieved in 20%. To date, perforation and other complications have not occurred. Mortality was zero. Our series was an uncontrolled trial, so the results are hardly comparable to other studies. Furthermore, the small number of patients in our study represents a weak point with regard to complications. We conclude that the main advantages of the procedure are its simplicity and practicability. The simple procedure may be the method of choice in elderly patients. Of course, no final decision can be made until a well-designed controlled trial has been carried out.
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Affiliation(s)
- E Eypasch
- II. Chirurgischer Lehrstuhl, Universität zu Köln, Federal Republic of Germany
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43
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Troidl H, Vestweber KH, Kusche J, Bouillon B. [Hemorrhage in peptic gastroduodenal ulcer: data as a deciding aid in the concept of surgical therapy]. Chirurg 1986; 57:372-80. [PMID: 3527591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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44
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Vestweber KH, Troidl H, Koslowski A, Bouillon B. [Gastric outlet stenosis (benign): definition, incidence, therapy?]. Langenbecks Arch Chir 1985; 366:107-11. [PMID: 4058148 DOI: 10.1007/bf01836612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
According to a strict definition of a benign gastric outlet obstruction i.e. delayed vomiting, changing of symptoms, weight loss and intraoperative test by Hegardilators (less than 14), 2.2% real stenoses among 619 operative treated duodenal ulcer patients were found. All patients were treated by SPV and digital dilatation of the stenosis through a gastrotomy. During up to a 10 year follow-up no reoperation was necessary. All patients showed Visick-classification of I and II. In conclusion SPV with digital dilatation showed good clinical results for patients with benign gastric outlet obstruction in long-term follow up.
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45
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Troidl H, Vestweber KH, Viell B, Krause B. [New technics for the implementation of enteral nutrition: a prospective study on the clinical usefulness of percutaneous endoscopic gastrostomy (PEG) and fine-needle catheter jejunostomy]. Z Gastroenterol 1985; 23 Suppl:29-37. [PMID: 3937350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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46
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Vestweber KH, Viell B, Troidl H, Krause B. [Indications and results of perioperative enteral nutrition with formula diets]. Z Gastroenterol 1985; 23 Suppl:82-9. [PMID: 3937357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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47
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48
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Viell B, Vestweber KH, Troidl H. [Dissociation behavior of peptide diets]. Infusionsther Klin Ernahr 1984; 11:197-201. [PMID: 6434420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The solution stability of different diets (Peptisorb, Salvipeptid, Survimed and Survimed neutral) was investigated. All diets exert a more or less cream formation. Additionally in some of them one can observe the sedimentation of particulates. When these diets were pumped out of the nutrient bag, as usually done in clinical practice during enteral nutrition, some of them produce an effluent, which contains a high portion of sedimenting particulates at the beginning of the infusion. All of them show a very high colloidal portion in the last pumping fraction. The question is raised, whether these phenomena may lead to an osmotic burden of the bowel, thus in consequence, causing the often observed diarrhoea in tube fed patients.
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49
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Troidl H, Vestweber KH, Sommer H, Tepner S. [Modern technics of tube feeding]. Leber Magen Darm 1984; 14:58-63. [PMID: 6438420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A prospective study was done in 101 patients and clinical usefulness of a fine needle-catheter-jejunostomy was investigated; this procedure was modified according to the procedure devised by Delany (2). The instruments used were two split canules and a polyurethane catheter (inner diameter 2.1 mm); these instruments are simple, safe and can be applied quickly. Formation of fistulae, peritonitis, ileus or deaths caused by the procedure could not be observed. The catheter needs to have certain mechanical qualities as e.g. sufficient rigidity. Percutaneous endoscopic gastrostomy is an alternative to corresponding surgery procedure. The stomach is punctured under sight and a Foley catheter is applied immediately. We performed this procedure without major complications in seven cases, and found it to be very useful. The techniques described here are essentially important if the advantages of the enteral as compared to the parenteral nutrition are to be made use of. As soon as the problems of diarrhea and belching are solved, tube feeding will offer in the near future a real alternative to parenteral nutrition, especially in patients who need long time artificial nutrition.
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Viell B, Vestweber KH. [Effect of immunoglobulin and antibiotic in E. coli infection of malnourished mice]. Immun Infekt 1984; 12:61-4. [PMID: 6398273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Malnourished mice, which exert a greater susceptibility to E.coli induced intraperitoneal infection than standard fed animals, cannot be protected by application of immunoglobulin (2 X 10(5) cells/animal). If, however, an antibiotic (mezlocillin, 500 mg/kg s.c.) is given shortly after infection, the surviving rate increases dramatically to 42%. This effect is enhanced to 63% survival, if the infected animals receive an additional dose of immunoglobulin.
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