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Biomedical subjects

B C Manegold

Publications and source records attributed to B C Manegold.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Peutz-Jeghers syndrome. Cases at the Mannheim clinic over 25 years].

Observations in our clinic and others reviewed in the literature result in a new picture of the Peutz-Jeghers syndrome. It turns out to be a hereditary polypose syndrome which is hard to define. The tendency to malignant degeneration of polyps and development of associated neoplasms is almost impossible to forecast. In addition operations frequently involve complications and often need to be repeated more than once. Radical removal of all polyps must be the aim of treatment; the patients must then be closely followed up by clinical examination, endoscopy and radiology to avoid complications of regrowth and to make sure degeneration and associated neoplasms are detected at an early stage.

Adolescent↗
PubMed1995

The value of histological analysis of occluded biliary endoprostheses.

BACKGROUND AND STUDY AIMS: Histological diagnosis of biliary strictures remains unsatisfactory, despite the availability of various endoscopic sampling procedures. The aim of our study was to assess the potential diagnostic yield of histological processing of occluded biliary endoprostheses inserted for palliation of malignant biliary stenoses. PATIENTS AND METHODS: Over a period of one year, we prospectively collected biliary endoprostheses at the time of stent removal due to stent obstruction. Thirty-nine stents, inserted a mean of 94 days earlier for presumed malignant biliary strictures, were recovered. Their contents were examined histologically by two independent pathologists. RESULTS: Malignancy was found in 14 of 36 patients (39%). The sensitivity was highest in gallbladder carcinoma (66%), followed by choledochal and ampullary carcinoma (50%), metastatic carcinoma (33%), and pancreatic carcinoma (25%). The specificity of the method was 100%. CONCLUSIONS: We advocate systematic histological or cytological examination, or both, of occluded biliary endoprostheses, since the technique is of low invasiveness, has low costs, and is easy to perform, especially if other methods of tissue diagnosis have failed.

Aged↗
PubMed1995

The optical "Veress-needle"--initial puncture with a minioptic.

Laparoscopic access is a necessary part of minimally invasive surgery. The double blind puncture with Veress-needle and trocar can cause lethal complications such as bowel injury, bleeding and gas-embolisation. Some authors have reported alternative techniques for laparoscopic abdominal access. Because no blind procedure can absolutely prevent injury, permanent visual control of perforated tissue layers as in open surgery should be achieved to prevent possible injury at an early stage. Previously described procedures could not fulfil all requirements to comply with this ideal, i.e. permanent visual control of abdominal wall penetration prior to establishment of pneumoperitoneum and trocar insertion without further possible damage. We designed a 2 mm fibreglass optic 250 mm in length that is inserted into a suitable cannula. Special construction allows rinsing through the cannula to clear the vision and to open spaces in the puncture track by water dissection. After incision of the skin, all layers of the abdominal wall can be visualised, including blood vessels and internal surfaces. Once the abdominal cavity is reached, the needle tip is retracted and a two-step dilation allows the trocar to be introduced via the puncture track. Only then does insufflation begin. The fibreglass optic-equipped safety needle was used for visually controlled access in 184 laparoscopic surgical procedures. After a period of training, all layers of the abdominal wall could be recognised exactly. In two patients with dense adhesions, perforation of the small bowel was diagnosed immediately by endoscopic viewing. The small injury needed no treatment, and the intended procedure was completed laparoscopically.(ABSTRACT TRUNCATED AT 250 WORDS)

Catheterization↗
PubMed1994

[Endoscopic hemostasis in stomach and duodenum].

Endoscopic hemostasis in cases of acute upper gastrointestinal bleeding may be achieved by various methods with comparable initial results, nevertheless the frequency of re-bleeding is different in regard to the techniques. The frequency of re-bleeding may be reduced by the application of fibrin tissue sealant, the eradication of Helicobacter pylori and by daily endoscopic controls. The use of big channel endoscopes makes intragastral survey easier, and beyond that endoscopic doppler-ultrasound may reveal visible and not visible arterial vessels on the bottom of the ulceration, so indicating the greater risk of re-bleeding. The progress of endoscopic hemostasis combined with specific pharmaco-therapy is on the way to relieve laparotomy in favour of intraluminal minimal invasive techniques in a larger scale.

Algorithms↗
PubMed1994

Complications in endoscopy of the lower gastrointestinal tract. Therapy and prognosis.

This is a report on 126 prospectively registered and controlled complications in 29,695 consecutive endoscopic procedures of the lower gastrointestinal tract. The overall complication rate is 0.4%. All endoscopic procedures were performed in our institution; no referrals "from other hospitals" are included. The therapy and prognosis of occurring complications are described. Especially after therapeutic endoscopy--above all, after polypectomy--the complication rate of 0.83% is not negligible. A serious aspect is the average interval of 30 h from endoscopically caused complication to the onset of symptoms. Bleeding could be managed conservatively in 76% of cases. Nevertheless perforation and transmural burn injuries required surgical intervention in 78% of cases. The authors conclude that in the case of transmural burn an attempt at "active conservative treatment" is justified if the patient is under close surgical control, if the symptoms improve, and if there is a possibility of immediate surgery.

Adult↗
PubMed1993

Electronic photography: a new age of medical imaging?

This is a critical overview of present conceptions of the introduction of electronic photography in medicine. It is not a complete list of products, rather it is a description of how the requirements of the physician have influenced medical illustration in the past and will continue to do so in the future. Video systems are widely used in medicine. Besides the learning and teaching of effects of television, minimal invasive surgery (MIS) has become reality through endoscopy, rapidly accepted worldwide. Documentation of endoscopic procedures and their effects is becoming routine. Therefore, the conversion of complex optical information into binary units is a logical development to save space for storage. The reproduction, storage and transfer of detailed images is already realized by digital camera systems, photo CD, scanners and picture archiving and communicating system (PACS). Now electronic imaging in medicine has to be regarded as a matter of routine. The real impact of accelerated editing will be shown in the future.

Computer Graphics↗
PubMed1992

[An interesting case--endoscopic hemostasis of an actively bleeding sigmoid diverticulum--a case report].

A pulsating arterial bleeding from a diverticulum, situated in the colon sigmoideum, was identified and stopped during video-documentation in a 70 year-old man. After injection with a solution of suprarenin, the diverticulum was turned out like a balloon into the colon and didn't show any signs of further bleeding until the patient was prepared for a semi-elective resection of the sigmoid. This case demonstrates that emergency endoscopy is an effective method for diagnosis and even therapy of massive lower intestinal bleeding which eventually has to be supplemented by radiological techniques like scintigraphy and arteriography.

Aged↗
PubMed1992

[Esophageal perforation in attempted ERCP].

In this report we refer to a 88-years old female patient who was admitted to our hospital under the diagnosis of cholecysto- and choledocholithiasis. Due to clinical symptoms, general performance status and sonographically proven dilated bile ducts emergency-ERCP was performed by an experienced endoscopist. Unfortunately esophageal perforation occurred due to subsequently diagnosed hiatus hernia. Potential pitfalls during examination as well as a concept of problem management during endoscopies with side-view optics will be discussed.

Aged↗
PubMed1991

Extracorporeal shock-wave lithotripsy and endoscopy: combined therapy for problematic bile duct stones.

Endoscopic treatment of bile duct stones is currently successful in 86% of patients. We prospectively studied the efficacy and complication rate of extracorporeal shock-wave lithotripsy (ESWL) of problematic bile duct stones combined with endoscopy. When stone removal was not possible, patients were subjected to ESWL. Fragmented stones were removed endoscopically. During 1 year, 220 patients presenting with choledocholithiasis were diagnosed and 188 were successfully treated endoscopically. In all, 3 subjects received alternative treatment and the remaining 29 (13%) constituted our study group; 19 (65%) were women and the mean age was 76.7 years. Overall, 22 (76%) were high-risk patients; 23 (79%) were jaundiced and 9 (31%) had cholangitis at admission. The most frequent indication for ESWL was stone size. Stone fragmentation was achieved in 80% of cases. Complications were mild and were managed conservatively. No patient died. Complete stone clearance was possible in 23 (80%) cases. The association of ESWL and endoscopy enhanced the success rate of endoscopic stone clearance from 86% to 96%. During the same period, open surgery was performed in 4 cases for residual common bile duct (CBD) stones and in 32 cases in association with simultaneous cholecystectomy.

Aged↗
PubMed1990

Long-term results of palliative endoscopic and surgical intubation of benign oesophageal stenoses.

Benign oesophageal stenosis can be treated by different methods. Besides surgical procedures and established conservative treatment (e.g. dilatation), more invasive endoscopic techniques such as cryosurgery and laser therapy have recently been developed. Intubation, which has been used to treat malignant strictures, can also be used in benign oesophageal strictures. Between 1977 and 1989 a total of 43 tubes were implanted in 26 patients (mean age 62.3 years). The mean duration of intubation was 149 days. We report our experience in patients intubated for (1) acid burns, (2) actinic strictures, (3) peptic strictures, (4) postoperative stenosis, (5) postoperative complications and (6) tracheo-oesophageal fistulae. We also discuss the complications (dislocation, disintegration, bleeding, perforation, operative removal) and long-term results. Because of the prolonged survival of patients with benign oesophageal stenosis, follow-up and late complications are of particular importance in this report. Despite drawbacks, intubation is an option in the management of patients with benign oesophageal stenosis.

Adult↗
PubMed1988

Endovision 534.

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Endoscopes↗