[Extracorporeal shock wave lithotripsy of gallstones. Methods, results and perspectives].
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Biomedical subjects
Publications and source records attributed to A Rambow.
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To evaluate, wether a new non-ionic contrast medium decreases the complication rate of endoscopic retrograde cholangiopancreaticography (ERCP), we performed a prospective randomized study in 46 indoor patients with suspected pancreatic or bile duct related disease. The low-osmolar low-viscosity non-ionic Iopromid (Ultravist, n = 15), the low-viscosity high-osmolar Ioglicinate (Rayvist, n = 18), and the conventional dissociable high-viscosity Ioxaglinate (Heaxbrix, n = 13), each presenting a iodine content of 300-320 mg/ml were compared. All three contrast solutions gave excellent imaging of pancreatic and bile ducts. No complications, particularly no pancreatitis were observed. Hexabrix caused significant elevations of gamma-GT from 126 U/l to 178 U/l and mof lipase from 144 U/l to 418 U/l (p less than 0.01), respectively. Following Rayvist or Ultravist injections, no significant changes of the leucocytes, SGOT, SGPT, gamma-GT, AP, lipase and amylase were observed. We conclude that ERCP performed by skilled investigators is a low risk procedure. Selection of suitable contrast media may diminish hepatotoxic and pancreatotoxic side effects. According to our results, we recommend low-viscosity contrast media (Rayvist, Ultravist). The presumed benefit of the non-ionic solution (Ultravist) could not be demonstrated.
In 15 patients with the history of bleeding from esophageal varices, confirmed cirrhosis of the liver (Child A) and esophageal varices (grade II, 2; grade III, 11; and grade IV, 2 patients) esophageal intravariceal pressures were endoscopically measured before and 10 min after intravenous administration of 1 mg glycylpressin. Pressures fell in the patients without previous sclerotherapy from 21.8 +/- 2.8 to 19.0 +/- 1.9 mm Hg (not significant), in those previously sclerosed from 18.0 +/- 1.4 to 14.5 +/- 1.0 mm Hg (p less than 0.05). In two of the non-sclerosed patients and one after sclerotherapy no change of pressure was recorded. The results indicate that glycylpressin has a relatively minor and uncertain effect on esophageal intravariceal pressure. In view of the possible side effects of the drug the indications for its use should be carefully weighed.
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We report a case of herpes simplex encephalitis (HSE) with initial coma and severe left-sided hemiparesis in which combined treatment with adenine arabinoside and acyclovir was followed by complete recovery. This favorable result is discussed in view of the literature of HSE treatment including experimental studies on antiviral activity of both drugs. Combined treatment may be useful in severe cases of HSE.
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