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Biomedical subjects

B Kohler

Publications and source records attributed to B Kohler.

114 records · Page 7Linked to original sources
PubMedDate not supplied

Endoscopy of the pancreatic duct: value of different endoscope types.

Diagnostic pancreatoscopy was performed in 38 patients with suspected lesions by means of an endoscopic retrograde approach using two different endoscope types. A 3.1-mm endoscope, which required sphincterotomy, and an 0.8-mm ultra-thin pancreatoscope, which could be passed through a standard catheter into the pancreatic duct, were used. Both endoscope types were effective in detecting and differentiating pancreatic lesions. The advantage of the 3.1-mm pancreatosope is its ability to take biopsy specimens, thus allowing histologic verification of observations. The ultra-thin endoscope may play a role in the initial duct examination.

Biopsy↗
PubMedDate not supplied

The role of endoscopic Doppler-sonography.

Endoscopic Doppler sonography is a useful method that permits a differentiation to be made between high-risk lesions in danger of rebleeding and prognostically harmless ulcerations. Using this technique, vessels in the base of the ulcer can be reliably identified, and the indication for local endoscopic treatment established. The pulsed Doppler can be used to test the efficacy of prior endoscopic therapy within the framework of follow-up investigations; when arterial blood flow signals are found to persist, treatment needs to be repeated. With the aid of this "programmed" Doppler sonography-controlled endoscopic approach, which in some cases may be repeatable, the number of rebleeds, emergency operations, and probably also mortality, can be permanently lowered. Endoscopic Doppler sonography can also provide important additional information in the area of primary diagnosis and endoscopic treatment of esophageal and gastric varices. The Doppler exploration facilitates the assessment of the sclerosing effect, and is capable of identifying gastric varices and distinguishing these from other submucosal processes. For an assessment of the butyl cyanoacrylate varix, the Doppler is of particular value.

Endosonography↗
PubMedDate not supplied

Endoscopic stenting in obstructive jaundice due to liver metastases: does it have a benefit for the patient?

BACKGROUND/AIMS: The goal of this report is to describe our experience with the palliative endoscopic treatment of jaundice occurring in the setting of liver and hilar metastases of a distant primary malignancy. MATERIAL AND METHODS: We retrospectively analyzed the clinical course of 29 consecutive patients with metastatic tumors not originating in the hepatobiliopancreatic area, who were treated by endoscopic retrograde cholangiopancreatography with endoprostheses insertion. RESULTS: We achieved a complete follow-up in 24 out of the 29 patients (11 women, median age 69 years). The primary tumor site was the colorectum in 15 patients, stomach in 4, lung in 2, breast and prostate in 1 and one patient had a lymphoma. The median bilirubinemia before therapy was 16 (1.8-31) mg/dl and the median minimum serum bilirubin reached after stenting was 2.6 (0.3-11.5) mg/dl. Stent dysfunction was observed in 33.5% of the patients and stent change was necessary 13 times. The median survival after therapy was 4 (2.5-19) months for patients with colon tumors and 3 (0.5-12) months in patients with other cancers. An improvement in the quality of life was obtained in 75% of the patients after endoscopic treatment. CONCLUSIONS: Endoscopic stenting should be attempted even on patients with obstructive jaundice due to liver metastases.

Aged↗
PubMedDate not supplied

[Endoscopic laser lithotripsy for difficult calculi after unsuccessful extracorporeal shock wave lithotripsy].

INTRODUCTION: More than 97% of common bile duct stones can be successfully managed by endoscopic papillotomy, mechanical lithotripsy and extracorporeal shock-wave lithotripsy. In this study, we evaluate the role of laser lithotripsy after failure of the above mentioned endoscopic methods. PATIENTS AND METHODS: Eighteen patients (15F, 3M; median age = 69 (28-83) years) were treated by endoscopic laser lithotripsy after ESWL failure. We employed a Rhodamine-6 G laser with a stone-tissue recognizing system. The laser fibers were cholangioscopically (direct vision) or blindly (under plain fluoroscopic control) placed. RESULTS: Seventeen patients were treated endoscopically and one was successfully managed percutaneously after failure of the transpapillary approach. Fourteen (78%) were stone-free after a mean of 1.56 laser therapy sessions alone. Two additional patients were successfully managed after partial fragmentation with combined treatment (mechanical lithotripsy: n = 1, electrohydraulic lithotripsy: n = 1). Overall, 89% of the patients were freed from their calculi. Cholangitis occurred once and the mortality was zero. CONCLUSIONS: We conclude that laser lithotripsy is an effective and safe treatment alternative in a highly selected patient population with difficult bile duct stones and considerable surgical risk.

Adult↗