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ABSTRACT: C-fos protein expression was investigated in the nucleus of the solitary tract (NTS) in response to increasing cholecystokinin (CCK) doses and food intake in rats by counting the number of c-fos protein positive cells in the NTS. C-fos protein expression in the NTS dose-dependently increased in response to CCK, the lowest effective dose being 0.1 microg/kg. The ED(50) for c-fos protein expression in the NTS in response to CCK was calculated to be 0.5 to 1.8 microg/kg, depending on the anatomical level of the NTS investigated. Food intake increased c-fos protein expression in the NTS, the maximum number of c-fos protein positive cells being reached at 90 min after the start of food intake. Regression analysis identified a positive correlation between c-fos protein expression and the amount of food intake. Our data indicate that subpopulations of the NTS that are activated by CCK or food intake are involved into the short-term regulation of food intake and the neural control of feeding by the caudal brainstem.
Brain Research 11/1999; 846(1):1-11. · 2.73 Impact Factor
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ABSTRACT: The combination of confocal laser scan microscopy and the pH-sensitive fluorescent dye BCECF allowed us to record simultaneously intracellular pH, cell viability and relative cell volume. pH was measured by using the pH-sensitive excitation wavelength at 488 nm and the pH-independent excitation wavelength at 442 nm to obtain ratio images. Cell volume was traced by measuring fluorescence dye concentration at 442 nm. Isolated villus tip rat duodenal enterocytes were exposed to 20 mM NH4Cl, sodium free, or 1 mM amiloride buffer. Sodium free buffer and amiloride buffer acidified the cells. Cell volume did not change in sodium free buffer, or NH4Cl exposure, but amiloride led to an increase in cell volume of 20%. After acidification of the duodenal cells, amiloride buffer increased cell volume by almost 50%. These studies revealed that cell volume regulation during pH changes in short-living cells could easily be detected by confocal microscopy and BCECF.
Research in Experimental Medicine 09/1998; 198(2):73-82.
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ABSTRACT: The majority of patients with Crohn's disease will eventually have colonic involvement, and more than 50% of these patients undergo resectional colonic surgery. The extent of colonic resection is discussed controversially.
We evaluated prognostic factors influencing the long-term outcome after resectional surgery including the colon.
We analyzed the postoperative course in 170 patients (mean follow-up 7.4 years) after first colonic surgery. Lifetable and multivariate factor analysis were performed to assess the influence of various factors on the postoperative long-term outcome. 85% of the patients had concomitant ileal disease, 40% had rectal disease, 48% percent of the patients had extensive colonic disease at the time of primary surgery.
In 17% of the initial operations a colectomy was performed, the remaining 83% operations consisted in segmental colonic resections. The cumulative risks of clinical recurrence/reoperation were 63%/33% after ten years and increased by the presence of anal fistulas (relative risk 1.7/3.0) and after colocolonic type of anastomosis (relative risk 1.9/2.8). Ileal disease, rectal disease, extent of resection and pattern of colitis did not influence the recurrence rates. The risk to undergo completion colectomy was 11% ten years after segmental resection and not higher in the presence of extensive colonic disease. The risk of a definitive stoma was 11% after ten years and higher after ileorectal anastomosis (25% versus 8% after segmental resection: p < 0.003).
Colocolonic type of anastomosis and the presence of anal fistulas are risk factors for recurrence after initial colonic resection. Segmental resections were not followed by increased recurrence rates or a higher stoma rate. To maintain colonic length and intestinal continuity segmental colonic resection is the treatment of choice in patients undergoing surgery for local complications, even in the presence of extensive colonic disease.
Zeitschrift für Gastroenterologie 08/1998; 36(8):619-24. · 0.90 Impact Factor
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ABSTRACT: Postoperative ileus influences patients well-being, hospital stay, and health cost, and postoperative inhibition of colonic motility is a major contributor to postoperative ileus. Experimental models for investigating postoperative ileus are needed. In particular, recording of postoperative colonic motility in awake rats has not been described yet.
Gastric, small intestinal, and colonic motility were recorded with strain gauge transducers in awake rats, and the effects of anesthesia and abdominal surgery on gastrointestinal motility were investigated.
Ether anesthesia increased gastric motility and inhibited small intestinal motility, while enflurane anesthesia had only minor effects on gastrointestinal motility. Abdominal surgery inhibited gastric, small intestinal, and colonic motility, and a detailed analysis of gastrointestinal motility in our postoperative ileus model is given.
We established a model to record gastric, small intestinal, and colonic motility in awake rats postoperatively. We could demonstrate that enflurane anesthesia had little effect on gastrointestinal motility, while laparotomy and short manipulation of the cecum produced a prolonged inhibition of gastrointestinal motility. Our model could be used to investigate postoperative ileus, particularly of the colon, in awake rats.
Journal of Surgical Research 03/1998; 74(2):112-8. · 2.25 Impact Factor
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ABSTRACT: Symptomatic gastroduodenal Crohn's disease (CD) is rare although new endoscopic/histologic data indicate a typical focally enhanced gastritis in up to half of all patients with CD. One third of the patients with symptomatic gastroduodenal CD undergo surgery, most of them for (gastro-) duodenal obstruction. Gastroenterostomy with vagotomy is the surgical treatment of choice. Resection, strictureplasty or balloon dilatation can be performed in selected patients. Enterogastric and enteroduodenal fistulas are rare, frequently missed during routine examination and often detected only during laparotomy. Treatment of those fistulas consists of resection of distal bowel (fistula origin) with suture closure of the fistula opening in the stomach/duodenum. Recurrence rate after surgery for gastroduodenal CD is lower than in ileal and/or colonic disease, and only a minority of the patients requires further surgical intervention. Bowel obstruction is a frequent indication for surgery in CD. Interventional or surgical therapy should be performed in chronic-recurrent obstruction, progressive stenosis and stenosis refractory to medical treatment. In short fibrous stenosis of the small bowel or ileocecal anastomosis without acute inflammation or perforating complications balloon dilatation or, if endoscopic access is not possible, strictureplasty should be performed. In all other cases, especially in colonic strictures with their increased risk of malignancy, resection is the treatment of choice. The results of balloon dilatation, strictureplasty or resection are comparable with five year reoperation rates reported between 20% and 38%.
Zentralblatt für Chirurgie 02/1998; 123(4):338-43. · 1.02 Impact Factor
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ABSTRACT: Studies indicate that gastrectomy might alter calcium and bone metabolism, resulting in bone disorders. No data are currently available on the prevalence of bone disorders after gastrectomy.
Sixty gastrectomy patients were investigated for serum parameters of calcium and bone metabolism 5 to 20 years postoperatively and compared to an age- and sex-matched healthy control population. Forty patients agreed to a radiological investigation of the spine by anterior-posterior and lateral radiographs of the thoracic and lumbar spine and by computed tomography (CT) osteodensitometry.
Serum calcium and 25-(OH)-vitamin D were decreased in gastrectomized patients, while parathyroid hormone and 1,25-(OH)2-vitamin D were increased. Serum parameters of calcium metabolism were altered in as many as 68% of patients. We found 31 vertebral fractures in 13 patients, 30 grade 2 vertebral deformities in 18 patients, and osteopenia in 15 patients, corresponding to a prevalence of 33%, 45%, and 37% in gastrectomized patients, respectively. The overall rate of gastrectomy patients having vertebral fractures and/or osteopenia was 55%. The risk of having a vertebral deformity was increased by more than sixfold after gastrectomy. Our study is the first report evaluating vertebral deformities in gastrectomized patients, and the largest series of gastrectomized patients investigated by CT osteodensitometry.
We found a high prevalence of bone disorders in gastrectomized patients, possibly resulting from disorders in calcium metabolism. Postgastrectomy bone disease might derive from a calcium deficit, which increases calcium release from bone and impairs calcification of newly build bone matrix.
The American Journal of Surgery 11/1997; 174(4):431-8. · 2.78 Impact Factor
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ABSTRACT: Gastric ulcer healing is mediated by various endogenous growth factors. In this experimental study effect of locally and systemically applied recombinant human transforming growth factor beta 3 (rhTGF-beta 3) on gastric ulcer healing was investigated in the rat.
Gastric ulcers were induced with a cryoprobe, and ulcer healing was evaluated 7 days after local infiltration (0.5 micrograms, 1.0 microgram, 2.5 micrograms, and 50 micrograms) or systemic (intravenous) application of TGF-beta 3 (500 micrograms/kg body weight). Compared with controls, a dose-dependent stimulation of ulcer healing (as evidenced by a reduction in ulcer size) was observed 7 days after local infiltration of TGF-beta 3 (1.0 microgram, 2.5 micrograms, and 50 micrograms). Corresponding increases in the levels of proliferating cell nuclear antigen (PCNA) and intracellular TGF-beta 3 expression and a downregulation of the TGF-beta type-II receptor expression were also observed in the granulation tissue of the ulcer margins. Systemic application of TGF-beta 3 produced effects similar to those observed after local treatment with 50 micrograms of the compound.
Local and systemic TGF-beta 3 treatment accelerates gastric ulcer healing in rats.
Scandinavian Journal of Gastroenterology 11/1997; 32(10):985-90. · 2.02 Impact Factor
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ABSTRACT: Disturbances in calcium and bone metabolism after gastrectomy have long been recognized. It has been suggested that due to impaired calcium absorption after gastrectomy, serum calcium is decreased, being counter-regulated by parathyroid hormone release and 1,25-(OH)2-vitamin D formation. Both parathyroid hormone and 1,25-(OH)2-vitamin D are known to release calcium from bone, resulting in bone mass loss and increased fracture risk in some of the gastrectomized patients. No therapy is currently generally agreed on, although supplementation of vitamin D and calcium has been suggested repeatedly. A review on the current understanding of calcium and bone metabolism after gastrectomy is given.
Der Chirurg 09/1997; 68(8):784-8. · 0.70 Impact Factor
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ABSTRACT: Nach Magenresektion oder Gastrektomie sind Störungen der Calcium- und Knochenstoffwechsels bekannt. Wahrscheinlich kommt
es postoperativ aufgrund einer verminderten Calciumabsorption zu einem Abfall des Serumcalciums. Als Gegenregulation wird
Parathormon ausgeschüttet und 1,25-(OH)2-Vitamin D neu gebildet, welche beide Calcium aus dem Knochen mobilisieren. Bei einem Teil der Patienten kommt es in der Folge
zu einer Abnahme der Knochenmasse mit einem erhöhten Frakturrisiko. Bisher liegen keine anerkannten Behandlungsempfehlungen
dieser Störungen vor, lediglich die Substitution von Vitamin D und Calcium wurde wiederholt empfohlen. Es wird eine Übersicht
über die derzeitigen Vorstellungen zur Regulation des Calcium- und Knochenstoffwechsels nach Gastrektomie gegeben.
Disturbances in calcium and bone metabolism after gastrectomy have long been recognized. It has been suggested that due to
impaired calcium absorption after gastrectomy, serum calcium is decreased, being counterregulated by parathyroid hormone release
and 1,25-(OH)2-vitamin D formation. Both parathyroid hormone and 1,25-(OH)2-vitamin D are known to release calcium from bone, resulting in bone mass loss and increased fracture risk in some of the
gastrectomized patients. No therapy is currently generally agreed on, although supplementation of vitamin D and calcium has
been suggested repeatedly. A review on the current understanding of calcium and bone metabolism after gastrectomy is given.
Der Chirurg 07/1997; 68(8):784-788. · 0.70 Impact Factor
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ABSTRACT: An improved technique was developed to measure intracellular pH-changes in in vitro duodenal mucosa. A confocal laserscan microscope was equipped with a second laser to permit dual wavelength excitation measurements employing BCECF (2'7'-bis-2-carboxyethyl-5-(and-6)carboxyfluorescein), a pH-sensitive fluorescent dye. Intact rat duodenal epithelium was mounted in a microperfusion chamber and loaded with BCECF via submucosal injection. Viability of the epithelial cells could be directly monitored by estimating the nucleus-to-cytoplasm ratio of the fluorescence intensity of BCECF. A calibration procedure using isolated duodenal cells, allowed estimation of the apparent intracellular pH. Initial apparent intracellular pH was 7.32 +/- 0.12, identical to that of isolated duodenocytes. Exposure of the duodenal epithelium to 60 mM NH4Cl led to a steady increase in apparent intracellular pH of 0.46 units within 2 min. Luminal application of 0.01 N HCl led to a steady decrease in apparent intracellular pH of 0.53 pH units within 1 min and was followed by a slow increase to baseline level after acid removal. Thus, confocal laserscan microscopy in combination with BCECF allowed noninvasive monitoring of intracellular pH-changes in single cells of an intact duodenal epithelium.
Zeitschrift für Gastroenterologie 05/1997; 35(4):263-70. · 0.90 Impact Factor
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ABSTRACT: Perianal disease is frequent in patients with Crohn's disease, and many of these patients will eventually have abscess formation. In a prospective follow-up study, we evaluated factors influencing the occurrence and recurrence of perianal abscesses.
Of 126 consecutive patients with perianal Crohn's disease seen regularly in an outpatient clinic, 61 (48.4 percent) had at least one perianal abscess (mean follow-up, 32 +/- 17 months). In all, 110 episodes of an abscess with 145 anatomically distinct abscesses were documented.
The occurrence of first abscesses was dependent on the type of anal fistula (ischiorectal, 73 percent; transsphincteric, 50 percent; superficial, 25 percent; P < 0.02). Surgical therapy consisted of seton drainage (34 percent), mushroom catheter drainage (49 percent), or incision and drainage (29 percent) and led to inactivation in all patients. Cumulative two-year recurrence rates after the first and second abscess were 54 and 62 percent, respectively. Abscess recurrence was less frequent in patients with a stoma (13 vs. 60 percent in patients without stoma after two years) and in patients with superficial anal fistulas (0 vs. 55 percent/56 percent in patients with transsphincteric/ischiorectal fistulas). Only two abscesses recurred within one year after removal of seton drainage, whereas 13 abscesses recurred with the seton still in place. Neither intestinal nor rectal activity of Crohn's disease significantly influenced the occurrence of an abscess. During the study period, only two patients developed partial stool incontinence.
Development of perianal abscesses in Crohn's disease depends on the fecal stream and the anatomic type of anal fistula. Seton and catheter drainage are safe and highly effective in treatment. Long-term use of setons to prevent recurrent abscesses is not supported by our data.
Diseases of the Colon & Rectum 05/1997; 40(4):443-50. · 3.13 Impact Factor
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ABSTRACT: Inflammation refractory to medical treatment frequently characterizes the course of Crohn's colitis, often leading to colectomy and need for a stoma. The influence of disease extent within the colon on prognosis and disease progress over time has not been studied so far.
We evaluated the disease progress and the long-term outcome in 323 patients with Crohn's colitis followed-up for a mean of 9.8 years.
The charts were analyzed retrospectively, the mean number of documented examinations was 18.5 per patient. The influence of disease pattern, rectal disease and perianal fistulas on the long-term outcome was evaluated using actuarial methods and independent factor analysis.
The probabilities of having pancolitis or rectal disease were 77.1% and 78.8% after 15 years, respectively, and higher in patients with initially left-sided or segmental colitis compared with right-sided colitis. The chance of having perianal fistulas was 43.3% after 15 years. The risk of undergoing resectional colonic surgery was 62.2% after 15 years and higher in the presence of right-sided colitis. The cumulative risk of colectomy was 18.2% after 15 years and higher in patients with pancolitis, left-sided colitis or in the presence of perianal fistulas. The 15-year probabilities of proctectomy (12%) and of having a temporary stoma (21%) were only influenced by the presence of perianal fistulas but not by rectal disease or pattern of colitis.
Most patients with colonic Crohn's disease will eventually have pancolitis but only 20% of them will loose the colon. The proctectomy rate is low despite a high frequency of rectal disease. Perianal fistulas and the presence of total or left-sided colonic involvement are adverse risk factors with regard to preservation of colonic length.
Zeitschrift für Gastroenterologie 02/1997; 35(1):7-14. · 0.90 Impact Factor
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ABSTRACT: The aim of this study was to revisit anal anatomy, to explain surgical terminology in perianal complications of Crohn disease, and to show the MR imaging findings of perianal fistulas and abscesses. To this end more than 200 patients were studied using surface coils (Helmholtz; phased array) at 1.0 and 1.5 T. Transverse and coronal T1- and T2-weighted images were obtained. Parks' classification was used to describe perianal abscesses and fistulas. This pictorial essay shows the normal anal anatomy and pathologic findings such as subcutaneous, para-anal, ischiorectal, intersphincteric, and supralevatoric abscesses and fistulas. MR imaging with surface coils is well suited to showing the anal anatomy and to reliably describing perianal abscesses and fistulas according to surgical terminology.
European Radiology 02/1997; 7(7):1035-42. · 3.22 Impact Factor
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ABSTRACT: In 591 patients with Crohn's disease, 1044 operations were performed within 16 years. The aim of this study was to evaluate the changes in treatment time, indication for surgery, surgical technique, and postoperative complications. There was a significant reduction in treatment time (in-patient), whereas the number of operations in general increased. The frequency of emergency operations has declined. The postoperative complication rate did not change, but there was a correlation between emergency operation and the complication rate. Surgery for perforating Crohn's disease, acute intestinal obstruction or intra-abdominal abscess also correlated with a significantly higher complication rate.
Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress 01/1997; 114:1128-31.
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ABSTRACT: A prospective study of clinical, manometric and proctographic results in 36 patients presenting for transanal endoscopic microsurgery was performed. Anorectal manometry showed no difference in maximal squeeze pressure before and 12 months after operation, but resting pressures were lower after surgery (mean(s.e.m.) preoperative 86.1(27.6) mmHg versus postoperative 67.2(23.2) mmHg, P < 0.05). The rectoanal inhibitory reflex was lost in a significant group of patients (reflex present in 34 of 36 patients before operation and in 27 of 36 12 months after operation, P < 0.05). Proctography, manometry and questionnaire showed preserved function of most modalities 12 months after operation such that if objective function was impaired clinical function was adequate.
British Journal of Surgery 03/1996; 83(2):211-3. · 4.61 Impact Factor
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British Journal of Surgery 01/1996; 82(12):1648. · 4.61 Impact Factor
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ABSTRACT: The clinical course of perianal fistulas and associated abscesses was evaluated prospectively in 90 patients with Crohn's disease. Fistula type, rectal disease, faecal diversion, and immunosuppression were examined as prognostic indicators for fistula healing and recurrence. Median follow up was 22 months. The outcome was evaluated with life table analysis. Prognostic factors were analysed by multiple regression. Inactivation was achieved in all patients. The risks of recurrent fistula activity were 48% at one year and 59% at two years. Fistulas were healed in 51% after two years but reopened in 44% within 18 months of healing. Faecal diversion and absence of rectal disease decreased recurrence rates (p = 0.019/0.04) and increased healing rates (p = 0.005/0.017). The outcome in patients with trans-sphincteric fistulas was better than that in those with ischiorectal fistulas but worse than in patients with subcutaneous fistulas (p = 0.015 for healing; p = 0.007 for recurrent fistula activity). After initial treatment about 20% of the patients were symptomatic and about 10% had painful events per six month period. Incontinence was rare and did not increase during the study period. Perianal fistulas and associated abscesses can be controlled safely by simple drainage of pus collections. Frequent reinfection and re-opening after healing of fistulas are characteristic. Fistula type, rectal disease, and stool contamination influence the clinical course. Only a few patients, however, have continuous symptoms from perianal fistulas.
Gut 12/1995; 37(5):696-701. · 10.11 Impact Factor
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ABSTRACT: A total of 36 rectal advancement flap repairs were performed in 32 patients with perianal Crohn's disease. There were 12 anovaginal and 20 trans-sphincteric fistulas. Patients were followed prospectively for a mean of 19.5 months to evaluate postoperative recurrence rate. The prognostic influence of fistula type, rectal disease, intestinal disease and faecal diversion on recurrence was assessed. Four of 36 repairs showed primary failure, the operated fistula recurred in 11 patients after a median of 7 months, and a new fistula developed in six patients. The fistula recurrence rate was higher in patients with anovaginal fistula or Crohn's colitis but did not correlate with disease activity. Transitory mild incontinence of stool was observed in one patient only. Although rectal advancement flap repair does not cure perianal fistulas in most patients with Crohn's disease, those without Crohn's colitis may have long-term benefit. Short-term improvement of symptoms justifies this simple procedure even in patients with anovaginal fistula.
British Journal of Surgery 06/1995; 82(5):603-6. · 4.61 Impact Factor
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ABSTRACT: Evacuation proctography is an important imaging method for the investigation of abnormalities of defecation. For this procedure, the most commonly carried out measurements are the ano-rectal angle and the position of the pelvic floor. The given mean values and the physiologically acceptable deviations vary just as much as the perceived clinical value of these measurements. 173 evacuation proctograms were evaluated in a prospective study; the subjective abnormalities were correlated with clinical findings. No significant correlation between the measurements from the proctograms and the clinical findings could be determined. The clinical relevance of these measurements is, therefore, uncertain.
RöFo - Fortschritte auf dem Gebiet der R 05/1994; 160(4):334-9. · 2.76 Impact Factor
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ABSTRACT: Magnetic resonance imaging (MRI) was undertaken in a prospective study of 34 consecutive patients (21 women, 13 men; median age 31 [18-53] years) suspected of having active perianal Crohn's disease. The results of the investigation were compared with those obtained by independent observers on proctological and intraoperative examination (n = 31). A total of 58 fistulas and 21 abscesses were noted intraoperatively, 47 fistulas and all 21 abscesses by MRI, and 40 fistulas and 13 abscesses proctologically. The proctological examination proved to be more sensitive in demonstrating short subcutaneous or anovaginal fistulas (three of four subcutaneous and two of five anovaginal fistulas were not shown by MRI). Intersphincteric, ischiorectal and supralevator involvement was shown better by MRI. These results indicate that in perianal Crohn's disease MRI is a useful addition to proctological examination.
DMW - Deutsche Medizinische Wochenschrift 01/1994; 118(49):1791-6. · 0.53 Impact Factor
