[Surgical therapy of rectal prolapse].

A review of literature and own clinical studies confirm that best postoperative functional results in complete rectal prolapse may be reached with rectopexy in combination with partial resection of the colon. Incontinence may be improved in 38% to 93%, depending on the author. Constipation may be reduced in 41% to 83% of the cases.

[Anorectal pull-through and vector volume manometry].

Anorectal manometry has been developed from an object of clinic oriented scientific interest to an established tool within the spectrum of proctologic diagnostics. At present it represents the only objective diagnostic method with regards to continence disorders; it is routinely applied in the evaluation of constipation, of incontinence, of pre- and postoperative conditions in diseases of the anorectum as well as in the indication and therapeutic control investigations during biofeedback training of the anal sphincter. The new technique of determination of the anal sphincter pressure vector volume allows for the most sensitive functional separation of patients with different degrees of continence; this method delivers a 3-dimensional graphic imaging of the sphincter pressure profile, thus allowing for an objective visualisation of the present mechanic defect and an aid in planning a surgical correction.

[Endo-anal sonography in diagnosis of fecal incontinence].

Endoanal ultrasound is a new imaging technique in the diagnostic work-up of patients suffering from anal incontinence. A standardised examination as well as hardware specific reference values for the sphincter muscles are of paramount importance to allow correct interpretation of the continence organ. At the University Hospital of Würzburg from 1.

[Etiology and epidemiology of anal incontinence].

Current epidemiological data about fecal incontinence are reviewed. Anatomy and physiology of the anal sphincter are described, and it is shown that continence relies on several interdependent anatomical and functional factors. Etiology of fecal incontinence is discussed and illustrated by clinical examples.

Schizophrenia and the dopamine-beta-hydroxylase gene: results of a linkage and association study.

Alterations in dopamine neurotransmission and disturbed norepinephrine activity have been implicated in the pathogenesis of schizophrenia. We considered the dopamine-beta-hydroxylase (DBH) gene located on the long arm of chromosome 9 (9q34.3) as a candidate gene for schizophrenia.

Normal CAG repeats in the Huntington gene in a family with benign familial chorea.

Benign familial chorea (BFC) is a rare neurological disease with an autosomal dominant transmission. The disorder is characterized by its early onset in childhood, a non-progressive course of choreatic movements and the absence of intellectual impairment. There is one study describing an expanded (CAG)n repeat in the gene IT15 (Huntington) on chromosome 4p (causative for Huntington's chorea) in a family reported to have BFC that was diagnosed on the basis of onset and non-progressive course.

[Differential concept on use of laparoscopic anti-reflux operations].

The introduction of laparoscopic technique in antireflux surgery has created hope for an improvement in patient outcome. Initial experience with minimally invasive procedures show that the application in antireflux surgery depends more on a differentiated indication for operation and an operative procedure designed to remove or compensate the underlying pathophysiologic functional defect. The method of access is of lesser priority.

Fiberoptic technique for 24-hour bile reflux monitoring. Standards and normal values for gastric monitoring.

Physiologic bile reflux was assessed in 27 in vivo test with healthy volunteers to define a standardized protocol and normal values for 24-hour enterogastric bile reflux monitoring (protocol with supine, upright, and meal phases and a free diet avoiding alcohol, smoking, and coffee, evaluation with different thresholds of absorbance units: 0.14, 0.25).

The mode of Roux-en-Y reconstruction affects motility in the efferent limb.

Objectives: To compare motility of a Roux-en-Y esophagojejunostomy after total gastrectomy with normal jejunal motility and to determine the effect on motility of the incorporation of a pouch in the reconstruction.

Design: Jejunal motility in normal subjects was compared with jejunal motility in the Roux-en-Y reconstruction with and without a Hunt-Lawrence pouch.

Setting: The case were collected during a 4-year period at a university hospital.

Peritoneal seeding of gallbladder cancer after laparoscopic cholecystectomy.

We report a case of peritoneal seeding of an unsuspected adenocarcinoma of the gallbladder following laparoscopic cholecystectomy despite the use of a retrieval bag. The metastasis developed at the umbilical trocar site, which was also used to extract the resected gallbladder. There was no evidence foe a leak of the retrieval bag.

[Prevalence of E. multilocularis in foxes in Styria taking into consideration biometrical methods].

The results of a survey covering whole of Styria/Austria, which was based on a biometrical sampling plan, showed the prevalence rate of E. multilocularis among foxes to be 3.6% (18 out of 500 examined foxes).

Allosteric modulation of [3H]flunitrazepam binding to recombinant GABAA receptors.

The allosteric modulation of [3H]flunitrazepam binding by gamma-aminobutyric acid (GABA), pentobarbital, (+)-etomidate, etazolate, alphaxalone, propofol and chlormethiazole was investigated in cerebellar membranes and membranes from human embryonic kidney (HEK) 193 cells transfected with alpha 1 beta 3 gamma 2 or alpha 1 gamma 2 subunits. Results obtained indicate that [3H]flunitrazepam binding to recombinant GABAA receptors consisting of alpha 1 beta 3 gamma 2 subunits could be modulated by these compounds in a way and with a potency similar to that observed in cerebellar membranes. In addition, it was demonstrated that not only receptors consisting of alpha 1 beta 3 gamma 3, but also those consisting of alpha 1 gamma 2 subunits exhibited [3H]flunitrazepam binding which could be stimulated by GABA.

Reconstruction of the food passage after total gastrectomy: randomized trial.

Controversial results have been reported regarding the importance of the duodenal food passage after total gastrectomy. There are a number of experimental and clinical studies showing an advantage for the jejunal interposition between esophagus and duodenum. Others favor the Roux-en-Y reconstruction, as it is technically less demanding.

Endogenous [3H]flunitrazepam binding in human embryonic kidney cell line 293.

Specific endogenous [3H]flunitrazepam binding sites were identified and characterized in membranes from the human embryonic kidney (HEK) cell line 293. A large part of these binding sites exhibited an intermediate affinity for [3H]flunitrazepam and a microM affinity for diazepam, clonazepam, 1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinolinecarboxam ide (PK 11195) or 4'-chlorodiazepam (Ro 5-4864). These sites, thus, resembled neither gamma-aminobutyric acidA (GABAA) receptor associated nor 'peripheral' benzodiazepine binding sites.

[Endorectal ultrasound for evaluating perirectal processes].

Between July 1992 and December 1993 we examined 258 patients by endorectal ultrasound at the Surgical Department of the University of Würzburg. In 24 (9.3%) patients we found 27 perirectal lesions.

Teaching upper gastrointestinal endoscopy: the pig stomach.

An easily applicable teaching and training technique for flexible endoscopy in the upper gastrointestinal tract is presented. Using a fresh, flushed-out pig stomach with adherent esophagus and duodenum, the trainee endoscopist can practice all the essential endoscopic diagnostic and interventional techniques. The teaching model proposed requires little preparation, represents a cheap and easy technique with widespread applicability, offers a high degree of learning efficiency, and is appropriate for specialized teaching courses.

Motility in the Hunt-Lawrence pouch after total gastrectomy.

Purpose: The aim of this study was to evaluate motility patterns of the Hunt-Lawrence pouch and the jejunal limb of patients reconstructed with a pouch after total gastrectomy, and to compare the findings in symptomatic patients to those without symptoms after the operation.

Patients And Methods: Thirty-three patients who had undergone post-gastrectomy pouch reconstruction were studied using a water-perfused motility system. In 21, the pouch was connected by a Roux-en-Y, and, in 12, by a jejunal interposition.

Twenty-four-hour gastric luminal pH in normal subjects: influence of probe position, food, posture, and duodenogastric reflux.

Objectives: The aim of this study was to determine the gastric pH at different levels in the stomach under varying physiological circumstances.

Methods: Simultaneous 24-hour ambulatory gastric pH monitoring was performed with multiple electrodes in 24 normal subjects, divided into groups of six, to study the influence of food, the supine posture, and physiological duodenogastric reflux on gastric pH in different parts of the stomach. In 18 subjects, simultaneous recordings were made from two electrodes positioned 5 and/or 10 cm below the manometrically-defined lower border of the lower esophageal sphincter and, in six subjects, from three electrodes, one positioned 5 cm below the lower esophageal sphincter and two others positioned 5 and 8 cm proximal to the pylorus.

Immunoaffinity purification of gamma-aminobutyric acidA (GABAA) receptors containing gamma 1-subunits. Evidence for the presence of a single type of gamma-subunit in GABAA receptors.

Two polyclonal antibodies were raised against the gamma 1-subunit of gamma-aminobutyric acidA (GABAA) receptors. One of these antibodies could be used for the immunopurification of GABAA receptors containing gamma 1-subunits. These receptors exhibited [3H]muscimol and [3H]flunitrazepam binding, and their benzodiazepine binding properties were dramatically different from those of receptors precipitated by anti-gamma 2- or anti-gamma 3-antibodies.

Determinants of hospital stay after modified radical mastectomy.

The most expeditious way of reducing surgical costs is through reducing hospital stay. Multivariate analysis was used to identify potentially alterable factors affecting postoperative hospital stay for 73 consecutive patients undergoing modified radical mastectomy by 6 surgeons during a 12-month period. Stepwise logistic regression was used to identify independently significant preoperative variables associated with hospital stays equal to or greater than the median of 5 days.

Technique, indications, and clinical use of ambulatory 24-hour gastric pH monitoring in a surgical practice.

Background: Prolonged pH monitoring is used increasingly to assess alterations of gastric luminal pH caused by gastroduodenal secretory and motor abnormalities. The clinical value of gastric pH monitoring, however, has been debated.

Methods: We obtained normal values for 24-hour ambulatory gastric pH monitoring in 50 healthy volunteers and evaluated its clinical use by monitoring pH in 285 consecutive patients with nonspecific foregut symptoms and duodenal ulcers (n = 33), gastric ulcers (n = 21), antral gastritis (n = 123), or no mucosal injury (n = 108).