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Biomedical subjects

B Kohler

Publications and source records attributed to B Kohler.

At least 73 records · Page 4Linked to original sources
PubMed1992

Intraductal shock-wave lithotripsy in complicated common bile duct stones.

Intracorporeal shockwave lithotripsy was performed in 36 patients with problematic common bile duct stones. All of the patients had undergone unsuccessful mechanical lithotripsy prior to this procedure. In 29 patients (80.6%), the stones were fragmented under cholangioscopic control and subsequently extracted with a Dormia basket. In seven patients, the procedure failed due to stone impaction or failure to intubate the common bile duct with a nasobiliary tube. No complications were observed. Cholangioscopically guided intracorporeal shockwave lithotripsy is a highly effective and safe procedure for the conservative treatment of complicated common bile duct stones.

Aged↗
PubMed1992

[Significance of the ulcer vessel in acute ulcer hemorrhage--value of local endoscopic therapy in combination with endoscopic Doppler ultrasound].

The acute ulcer hemorrhage is one of the most frequent diagnoses in Gastroenterology. In addition to the active hemorrhage the visible ulcer vessel, even if not bleeding at present, is one of the most important prognostic criteria. Numerous controlled studies have shown that with this sign recurrent hemorrhages will occur in up to 81%, resulting in emergency surgery in up to 56% with an associated mortality of up to 21%. By a meta-analysis we could show that prophylactic endoscopic therapy can significantly reduce both the rate of recurrent hemorrhage as well as emergency surgery. If the endoscopic doppler is used as well, as diagnostic as well as follow-up examination, the effectiveness of endoscopic treatment is greatly improved. The numbers we present show that active local endoscopic therapy should be undertaken in a visible ulcer vessel.

Arteries↗
PubMed1992

[Stomach wall abscess--endoscopic diagnosis and therapeutic possibilities].

This is a case report of a rare gastric wall abscess of a 70 year-old woman who came to hospital with non-characteristic pain in the upper abdomen. The diagnosis was made by endoscopy. After endosonography the patient was treated by endoscopic drainage, antibiotics and abstinence of food. Two weeks later the abscess had healed. Subsequently recurrent arterial emboli occurred in the left leg leading to several operations. Two months after hospitalisation the woman died as a result of circulation failure induced by septicaemia. Surprisingly, post mortem examination showed endocarditis of the mitral valve with septical metastases in multiple organs. A review of the literature is given and etiology and pathogenesis of the gastric wall abscess are reviewed. The surgical treatment is compared with endoscopic therapy.

Abscess↗
PubMed1992

The efficacy of halofantrine in the treatment of acute malaria in nonimmune travelers.

A multicenter prospective trial was performed to investigate the efficacy and the tolerability of halofantrine in nonimmune patients with malaria imported from areas with drug-resistant falciparum parasites (mainly Africa). Forty-five of the 74 subjects were treated with a one-day regimen (3 x 500 mg) of halofantrine, and the other 29 received the same regimen with an additional treatment on day 7. In the second group, a 100% efficacy rate was demonstrated, but in the group receiving the one-day regimen, four recrudescences were observed in patients with falciparum malaria. Only five mild adverse reactions were seen, which disappeared spontaneously after the end of the treatment. We conclude that halofantrine is highly effective in curing malaria in nonimmune subjects. The treatment scheme for such persons should include an additional treatment on day 7 for nonimmune individuals. This drug was well tolerated in our patients, indicating that halofantrine will be useful in the treatment of multidrug-resistant malaria in nonimmune persons.

Acute Disease↗
PubMed1991

[Diagnosis of rare causes of upper gastrointestinal tract bleeding].

Possible errors in diagnosing rare sources of bleeding were analysed in 433 consecutive patients examined for upper gastrointestinal bleeding between May 1987 and June 1990. Rare lesions not necessarily recognizable as sources of bleeding were found in 14 patients (8 women and 6 men; mean age 66 [46-82] years). In 9 of the 14 the lesion was above the ligament of Treitz and thus accessible to routine esophagogastroduodenoscopy. Nonetheless, in 4 of these 9 cases the source of bleeding was not recognized at the first gastroscopy. They were all lesion in the region of the horizontal duodenum or Treitz's ligament (3 duodenal carcinomas, 1 aortoduodenal fistula). This finding indicates that, if the deep duodenum cannot be assessed with certainty in the initial gastroduodenoscopy, the region should be selectively studied endoscopically or radiologically before more invasive examinations are undertaken. In the remaining 5 of the 14 patients the source of bleeding was distal to Treitz's ligament. After the usual diagnostic tests (esophagogastroduodenoscopy, coloscopy, small intestine double-contrast imaging, angiography, scintigraphy) the sources of bleeding (angiodysplasias, jejunitis, enteritis) were confirmed in four patients by intraoperative ileo-jejunoscopy. In three of the latter cases bleeding did not recur after operative intervention, in one patient with multiple angiodysplasias severe bleeding recurred immediately after operation.

Aged↗
PubMed1991

The endoscopic Doppler: its value in evaluating gastroduodenal ulcers after hemorrhage and as an instrument of control of endoscopic injection therapy.

In this prospective study of 80 patients with active bleeding from the gastrointestinal tract a Doppler ultrasonographic investigation of the gastroduodenal ulcers was performed, in addition to immediate endoscopic examination. Admitted to this study were ulcers with the stigmata of acute bleeding, such as a visible blood vessel in the ulcer floor, a blood clot, or a black base and Forrest III lesions. In 52 patients Doppler ultrasonography was able to document unequivocally a superficial blood vessel. Complete agreement of endoscopic and Doppler results was obtained in only 49% of the cases. When a blood vessel was positively identified, local injection of epinephrine and polidocanol was carried out. Thereupon, in the further course, the acoustic signal was shifted into deeper regions or disappeared entirely. In 8% of the cases initial sclerosing was followed by a rebleed, which was again treated by injection therapy. None of the patients died of their GI hemorrhage. Endoscopic Doppler ultrasonography is a new and effective procedure that enables objectification of the endoscopic findings. It identifies the indication for proceeding to operative endoscopy and can monitor the effectiveness of the latter.

Adult↗
PubMed1991

Upper GI-bleeding--value and consequences of emergency endoscopy and endoscopic treatment.

Emergency endoscopy permits the early detection and prognostic evaluation of a source of hemorrhage. It serves as a "baseline" for decision-taking with regard to subsequent therapeutic measures. Today, modern endoscopic hemostatic procedures provide us with effective means of achieving primary control of the bleeding. Endoscopic emergency treatment can reduce the rebleed rate and help reduce the number of emergency surgical operations that need to be performed. A significant reduction in mortality rate has, so far, been observed in only a few comparative studies. When hemostasis has been accomplished, interdisciplinary discussions with the surgeon are needed in order to determine how to proceed in the individual case.

Emergencies↗
PubMed1991

[Importance of cardiocirculatory and pulmonary monitoring in endoscopic retrograde cholangiopancreatography (ERCP)].

Among the side effects of endoscopy, cardiopulmonary complications are particularly important. This risk appears to be greatest in endoscopic retrograde cholangio- and pancreaticography (ERCP) because of the patient's prone position, iv sedatives and analgetics and the relatively long duration of the examination. We studied 75 patients (50 patients without and 25 patients with premedication) who were to undergo ERCP and looked at these data: age, weight, premedication, accompanying diseases, reason for this examination, blood count, oxygen saturation SaO2 (pulse oximeter), pulse, blood pressure and length of the examination. Overall, the oxygen saturation decreased considerably and two patients only had 69%. Pulse rate increased and one patient had 205 beats per minute, one 172. We looked for a correlation between SaO2, pulse rate and blood pressure and studied the patients' usual medication, the length of the ERCP, the indication for ERCP, age and hemoglobin. There was no correlation. But all patients suffering from a compromised cardiopulmonary status had received a rather heavy premedication and the ERCP was longer than in other patients. Since it is not clear which patients may develop cardiopulmonary complications, it is advisable to monitor all patients by pulse oximeter in order to avoid these complications. This seems also advisable because the rooms where the examination takes place are darkened and the patient is in a prone position so he cannot be seen clearly.

Adult↗
PubMed1991

[Differential indications for peroral pancreaticoscopy].

Pancreatoscopy by the new mother-baby-endoscopy-system is an effective and safe diagnostic technique. Before the pancreatic duct can be entered by the pancreatoscope (diameter 3.2 mm), a sphincterotomy of the pancreatic sphincter must be performed. In 11 of 13 cases, the macroscopic and cytologic or histologic diagnosis respectively could be made. Main indications for this technique are intraductally localized lesions, where endoscopically guided cytology or histology can clarify the dignity of the lesion.

Ampulla of Vater↗
PubMed1990

[Pancreatitis-induced pseudocysts of the spleen: a rare complication].

Secondary splenic cysts usually occur following blunt abdominal trauma. In rare cases, the spleen can be affected in pancreatitis. Since the clinical findings are fairly uncharacteristic, this was a difficult diagnosis to make before imaging examination techniques became available. These cysts only became apparent as a result of their complications. Today, thanks to sonography and abdominal CT-scan, these cysts can be detected in their asymptomatic stage. Furthermore, interventional sonography allows the puncture and drainage of these cysts, and this technique is thus an alternative to surgery. Two cases of pancreatitis with splenic involvement are presented.

Adenocarcinoma↗
PubMed1990

Human strains of mutans streptococci show different cariogenic potential in the hamster model.

The cariogenic potential of fresh humans strains of Streptococcus mutans and Streptococcus sobrinus was examined in hamsters maintained on a high sucrose diet. The strains 1B 16 (S. mutans) and B13 (S. sobrinus) isolated 20-25 yrs ago served as positive controls. Three series of experiments were run. Some strains were tested once and some strains were tested in all 3 experiments. The animals infected with S. sobrinus strains generally showed lower caries scores than those infected with S. mutans strains. Among the groups infected with the different strains of S. mutans the caries scores varied. In one of the experiments the caries score of the animals infected with one of the Icelandic S. mutans strains was significantly higher than that of the positive control group and the group infected with one of the fresh Swedish isolates. Thus, different strains of mutans streptococci where shown to induce varying caries activity in the hamster model.

Adolescent↗
PubMed1990

[Mucinous cystadenoma of the pancreas--exact endoscopic assessment with pancreoscopy].

Mucinous cystadenomas of the pancreas are rare tumors of the exocrine pancreas with a well-documented risk for malignant degeneration. We present 2 patients with this cystic pancreatic neoplasia who were admitted with signs of obstructive pancreatitis. The exact diagnosis was found preoperatively by a new endoscopic technique: mother-baby duodenoscopy. The small-caliber endoscopy allows the precise description of intraductal tumors. Histological resp. cytological specimens obtained under direct optical control, allow for an exact pathoanatomical classification. This modern endoscopic system is an important addition for diagnosing intraluminal tumors of the hepato-biliary system.

Biopsy↗
PubMed1989

[Transpapillary cholangioscopy. A new diagnostic and therapeutic dimension].

Transpapillary cholangioscopy (TCS) was performed in 52 patients (12 men, 40 women; mean age 61.6 [39-86] years) in whom endoscopic retrograde cholangiography had not provided a firm diagnosis. TCS was unsuccessful in five patients for technical or anatomical reasons. In 33 of the remaining 47 patients (70%) the procedure gave diagnostically or therapeutically useful results: In seven patients with tumour in the biliary tract biopsies were obtained, while in eight with extraductal stenoses cholangiography was made possible and provided the diagnosis. In eight patients residual gall stones were removed; in three cholangioscopically guided lithotripsy was successful. TCS proved to be a simple method with few complications; it significantly improved the diagnosis and treatment of diseases in the biliary tract.

Adult↗