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Biomedical subjects

C Ell

Publications and source records attributed to C Ell.

At least 37 records · Page 2Linked to original sources
PubMed2001

[Neck swelling as the major symptom of lymph node and intestinal tuberculosis].

BACKGROUND: Gut tuberculosis appears to be a rare diagnosis in Central Europe. The main diagnostic method is endoscopy with biopsy in order to win histology and a culture. By means of endoscopy the differential diagnosis to Crohn's disease is sometimes difficult. Computertomography and/or ultrasound can facilitate the diagnosis of gut tuberculosis. CASE REPORT: A 64-year-old woman presented in our hospital with cervical lymph nodes and ulcerations in the cecum and near the ileocecal valve. Major symptoms were abdominal pain, loss of weight, diarrhea and febrile temperature. Histology and culture revealed tuberculosis. The common antituberculotic therapy had to be stopped due to severe allergic reaction. After desensitization the patient could be treated successfully with a triple antituberculotic therapy without further complication. CONCLUSION: Beside the early treatment with tuberculotic drugs it is very important to consider the differentiation of a gut tuberculosis.

Antitubercular Agents↗
PubMed2001

Lower intestinal bleeding.

Lower gastrointestinal tract bleeding is a frequent cause of physician consultations and hospital admissions. Clinical presentation is predictable and significantly influences subsequent patient management. Controversy surrounding diagnosis and treatment of lower gastrointestinal bleeding results from a surprising lack of prospective controlled data. Thus, selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithm approach. Advances in endoscopic, radiological and surgical equipment and techniques offer promising new diagnostic and therapeutic modalities, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. The present chapter will address clinical presentation, aetiology, diagnosis and treatment of lower gastrointestinal tract bleeding.

Colitis↗
PubMed2001

Management of Barrett's oesophagus, dysplasia and early adenocarcinoma.

There has been a dramatic increase in recent years in the incidence of Barrett's oesophagus and the oesophageal adenocarcinoma associated with it. Adequate monitoring strategies and improved diagnostic procedures are therefore essential. Alongside conventional video-endoscopy with four-quadrant biopsies, many additional diagnostic procedures are now available to improve monitoring. These allow the early diagnosis of dysplastic areas and early carcinomas. Both thermal procedures (argon plasma coagulation, multipolar electrocoagulation and KTP laser and Nd∶YAG laser treatment) and non-thermal ablation procedures (photodynamic therapy) are used for the endoscopic ablation of Barrett's mucosa without dysplasia, being employed in addition to acid suppression treatment. On the basis of the data currently available, it is, however, not yet possible to offer a general recommendation in favour of endoscopic ablation. Alongside surgical treatment for high-grade dysplasia and early carcinoma, endoscopic treatment procedures, which have a much lower complication and mortality rate, will probably play an important role in the future. Endoscopic mucosal resection and photodynamic therapy are particularly promising. Long-term results with these procedures are, however, still awaited.

Adenocarcinoma↗
PubMed2001

Gastrointestinal bleeding in the elderly.

Gastrointestinal bleeding in elderly individuals is a frequent cause of consultation with a physician and of hospital admissions. Co-morbidity and greater medication use in this steadily growing patient group influence the clinical course and adversely affect outcome. Clinical presentation is often predictable and guides subsequent patient management. Due to a surprising lack of prospective controlled data in the area of gastrointestinal bleeding, the selection of diagnostic and therapeutic manoeuvres often depends more on local expertise and availability than on an algorithmic approach. Advances in endoscopic, medical, radiological and surgical treatment modalities offer promising new diagnostic and therapeutic tools, particularly in concerted applications. Outcome studies on the appropriate sequence and linking of these modalities are urgently needed. This chapter will address clinical presentation, aetiology, diagnosis and treatment of both upper and lower gastrointestinal bleeding in the elderly.

Aged↗
PubMed2001

The AMOR study: a randomized, double-blinded trial of omeprazole versus ranitidine together with amoxycillin and metronidazole for eradication of Helicobacter pylori.

BACKGROUND: Besides antibiotics, additionally effective acid inhibition is necessary for the eradication of Helicobacter pylori. OBJECTIVE: To assess the significance of acid suppression and, in particular, treatment with proton pump inhibitors (PPIs) compared with H2 receptor antagonists (H2 RAs). The primary target parameter for the study was H. pylori eradication. In addition, the ulcer healing rate, speed of pain reduction, score for gastritis in the antrum and gastric body, and rate of side effects were recorded. DESIGN: Randomized, double-blinded, multicentre study. PARTICIPANTS: A total of 456 patients between the ages of 18 and 80 years with H. pylori-positive duodenal ulcers were included in the study. METHODS: Using a randomization list, patients were assigned either to a treatment group receiving omeprazole 40 mg once daily, amoxycillin 750 mg three times a day, and metronidazole 500 mg three times a day (OAM), or to a group receiving ranitidine 300 mg once daily, amoxycillin 750 mg three times a day, and metronidazole 500 mg three times a day (RAM). The treatment period was 7 days in both groups. Long-term acid-suppressant treatment was not given. RESULTS: The eradication rate was 87.1% (169/194, intention to treat [ITT]) in the OAM group and 77% (137/ 178, ITT) in the RAM group. The difference of 10.1% (95% CI 2.5-18%) is statistically significant (P= 0.0104). The ulcer healing rate was 93.3% in the OAM group (181/194, ITT) and 92.1% in the RAM group (164/178, ITT, NS). With regard to the speed and intensity of pain reduction, the OAM group was superior to the RAM group. In patients in whom H. pylori eradication was successful, the reduction in the antral and gastric body gastritis score was significantly greater than in patients without eradication. In the OAM group, 39.1% of the patients (n = 90) reported one or more side effects, compared with 44.7% (n = 101) in the RAM group (P= 1.5449, NS). CONCLUSION: Omeprazole (40 mg once daily in the morning) is significantly more effective than ranitidine (300 mg once daily in the morning) with respect to H. pylori eradication when used together with amoxycillin (750 mg three times a day) and metronidazole (500 mg three times a day) for a 7-day treatment period.

Adolescent↗
PubMed2001

Development of early gastric cancer 4 and 5 years after complete remission of Helicobacter pylori associated gastric low grade marginal zone B cell lymphoma of MALT type.

AIM: To report 3 of 120 patients on the German MALT lymphoma trial with H. pylori associated gastric MALT lymphoma who developed early gastric cancer 4 and 5 years, after complete lymphoma remission following cure of H. pylori infection. PATIENTS AND RESULTS: Three patients (two men, 74 and 70 years; one women, 77 years) with H. pylori-associated low-grade MALT lymphoma achieved complete lymphoma remission after being cured. Surveillance endoscopies were performed twice a year in accordance to the protocol. Four years after complete lymphoma remission in two patients, and after 5 years in the other, early gastric adenocarcinoma of the mucosa-type, type IIa and type IIc, respectively, was detected, which were completely removed by endoscopic mucosa resection. In one patient, the gastric cancer was diagnosed at the same location as the previous MALT lymphoma, in the other patients it was detected at different sites of the stomach distant from location of the previous MALT lymphoma. The patients were H. pylori negative during the whole follow-up time. CONCLUSION: These findings strengthen the importance of regular Long-term follow-up endoscopies in patients with complete remission of gastric MALT lymphoma after cure of H. pylori infection. Furthermore, gastric adenocarcinoma may develop despite eradication of H. pylori.

Adenocarcinoma↗
PubMed2000

Quantum correlations in the nonperturbative regime of semiconductor microcavities.

The nonlinear optical response of semiconductor microcavities in the nonpertubative regime is studied in resonant single-beam-transmission and pump-probe experiments. In both cases a pronounced third transmission peak lying spectrally between the two normal modes is observed. A fully quantized theory is essential for the agreement with the experimental observations, demonstrating that quantum fluctuations leading to intraband polarizations are responsible for this effect.

Journal Article↗
PubMed2000

Dominance of radiative coupling over disorder in resonance Rayleigh scattering in semiconductor multiple quantum-well structures.

Resonance Rayleigh scattering by periodic semiconductor multiple quantum-well structures is studied experimentally and theoretically. Polaritonic effects are found to dominate disorder in the secondary emission dynamics. The coexistence of several radiant polaritonic modes with different radiative decay times leads to polarization beating between modes, strongly influences the rise times, and determines the fast decay times of the resonance Rayleigh scattered signals.

Journal Article↗
PubMed2000

Photodynamic therapy.

Photodynamic therapy (PDT) is a treatment modality that utilizes a photosensitizing drug activated by laser-generated light and is proving effective for oncologic and nononcologic applications in the gastrointestinal tract. This article provides an overview of the most frequently used photosensitizers and clinical PDT studies in the upper gastrointestinal tract. In the future, the best indications for PDT in the esophagus will not comprise the palliative treatment of obstructing tumors but precancerous lesions such as Barrett's esophagus with or without dysplasia and early cancer. PDT might establish itself as a minimally invasive treatment alternative compared with surgery for high-grade dysplasia or early mucosal cancer of the esophagus.

Esophageal Neoplasms↗
PubMed2000

Rectal stricture associated with the long-term use of ibuprofen suppositories.

Here, we report the case of a 64-year-old woman who suffered from chronic lower backache for which she received ibuprofen suppositories. The patient was admitted to the hospital with a suspected rectal tumor. Clinical examination did not reveal any abnormal finding apart from a mild, bilateral peritibial edema. On rectal examination, an area of stenosis was detected approximately 7 cm above the anal verge. All laboratory parameters, including different tumor markers, were within normal range. Pelvic CT scan and colonoscopy revealed a circular rectal stenosis with severe destruction of the rectal mucosa. The rectal biopsy taken during endoscopy showed severe acute and chronic ulceration, chronic granulation and fibrosis with lymphocytic infiltration. After exclusion of sexually transmitted diseases such as syphilis and lymphogranuloma venerium or exposure to drugs as a possible cause of rectal stenosis, the history in this particular case suggests that the prolonged use of the cyclooxygenase (COX) inhibitor "ibuprofen" as a suppository is the cause of mucosal destruction and rectal stenosis.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Endoscopic mucosal resection of early cancer and high-grade dysplasia in Barrett's esophagus.

BACKGROUND & AIMS: In view of the mortality and morbidity rates of esophagectomy and the relatively large group of inoperable patients, local therapeutic techniques are required for high-grade dysplasia and early Barrett's cancer. METHODS: A prospective investigation of endoscopic mucosal resection was conducted in 64 patients (mean age, 65 +/- 10 years) who had early carcinoma (61 patients) or high-grade dysplasia (3 patients) in Barrett's esophagus. Thirty-five patients met the criteria for low risk: macroscopic types I, IIa, IIb, and IIc; lesion diameter up to 20 mm; mucosal lesion; and histological grades G1 and G2 and/or high-grade dysplasia (group A). The remaining 29 patients were included in group B (high risk). RESULTS: A total of 120 resections were performed, with no technical problems encountered. The mean number of treatment sessions per patient was 1. 3 +/- 0.6 in group A and 2.8 +/- 2.0 in group B (P < 0.0005). Only one major complication occurred, a case of spurting bleeding, which was managed endoscopically. Complete local remission was achieved significantly earlier (P = 0.008) in group A than in group B. In May 1999, complete remission had been achieved in 97% of the patients in group A and in 59% of those in group B; however, 1 patient in group A and 9 in group B are still undergoing treatment or awaiting the first check-up. During a mean follow-up of 12 +/- 8 months, recurrent or metachronous carcinomas were found in 14%. CONCLUSIONS: Endoscopic mucosal resection of early carcinoma in Barrett's esophagus is associated with promisingly low morbidity and mortality rates. The procedure may offer a new minimally invasive therapeutic alternative to esophagectomy, especially in low-risk situations. Comparisons with surgical results will need to be done when the long-term results of this procedure become available.

Adult↗
PubMed2000

Analysis of the risk factors associated with endoscopic sphincterotomy techniques: preliminary results of a prospective study, with emphasis on the reduced risk of acute pancreatitis with low-dose anticoagulation treatment.

BACKGROUND AND STUDY AIMS: The aim of the present study was to analyze the risk factors associated with complications of endoscopic sphincterotomy (ES). PATIENTS AND METHODS: In all consecutive endoscopic sphincterotomies carried out between September 1994 and December 1996, the possible risk factors (12 patient-related factors and 12 procedure-related ones), as well as the concomitant medical treatment, indications, techniques, and success of endoscopic sphincterotomy were evaluated prospectively. Risk factors were analyzed on an exploratory basis using univariate methods. "Potential risk factors" (univariate, P<0.1) underwent multivariate analysis to determine independent "risk factors" (multivariate, P<0.05). In addition, the complication rate was calculated according to the number of potential risk factors present. RESULTS: A total of 438 patients who underwent ES were analyzed. Complications occurred in 7.5% (n = 33; acute pancreatitis 4.3%, hemorrhage 2.3 %, cholangitis 0.9%, technical 0.2%). Statistical analysis of the complications identified three independent risk factors (coagulopathy, patient age (< or =60 years, pancreas divisum), and one protective factor (pancreatic duct obstruction). The frequency of acute pancreatitis was increased by two independent risk factors (pancreas divisum, ES frequency <40 procedures/year) and was reduced if low-dose anticoagulation (unfractionated heparin or low molecular weight heparin) was administered (0.9%, one of 115 vs. 5.8%, 18 of 313; P<0.05). The effect of anticoagulation was not confounded by the presence or absence of other potential risk factors for acute pancreatitis. Neither the risk nor the severity of hemorrhage were increased by low-dose anticoagulation. Due to the low number of events, only potential risk factors for hemorrhage were identified (coagulopathy, intensive-care treatment). The overall complication rate and the incidence of pancreatitis and hemorrhage increased significantly depending on the number of simultaneous potential risk factors present (P<0.0001). CONCLUSIONS: Patients at risk for complications after endoscopic sphincterotomy can be identified by risk factor analysis. These data suggest the hypothesis that low-dose anticoagulation prior to endoscopic sphincterotomy reduces the risk of acute pancreatitis after sphincterotomy.

Acute Disease↗
PubMed2000

The Erlangen Endo-Trainer: life-like simulation for diagnostic and interventional endoscopic retrograde cholangiography.

The Erlanger Endo-Trainer offers a large spectrum of training possibilities in endoscopic techniques using life-like biological specimens. We organised the first pilot study of interventions at the papilla and the bile duct under x-ray control. Specially prepared upper visceral porcine organ packages including the esophagus, stomach, duodenum, liver, gallbladder and bile ducts were implanted into the Endo-Trainer. Furthermore, small stones were introduced into the bile duct. The test study was carried out by a senior endoscopist assisted by his endoscopy nurse. The following steps could therefore be carried out as a structured team-training scheme: Introduction of the side-viewing endoscope and passage into the duodenum; identification and adjustment at the papilla; cannulation of the papilla; selective bile duct imaging with contrast application under x-ray vision; placement of a guidewire; papillotomy; stone extraction and finally placement of a plastic stent. The special value of this type of simulation is the fact that endoscopic techniques can be trained in the usual manner with real tissue-feeling using regular commercial instruments. Although there is general consent that individual practice on the patient cannot be completely replaced by simulator training, a suitable and realistic simulation model can be of great value, for initial steps prior to "real" patient contact as well as for refining techniques and tactics.

Animals↗
PubMed2000

Is endoscopic drainage of common bile duct stenoses in chronic pancreatitis up-to-date?

OBJECTIVE: Common bile duct (CBD) stenoses often complicate chronic pancreatitis (CP). Although endoscopic drainage is employed as a standard procedure in malignant CBD stenoses, it is not yet the approved standard therapy of CBD stenosis in CP. METHODS: The records of 31 patients with CBD stenosis in CP who had undergone endoscopic placement of plastic endoprostheses into the bile duct between January 1991 and February 1997 were analyzed retrospectively. In all, 18 patients suffered from jaundice and 13 patients exclusively showed serological cholestasis. Upstream dilation of the CBD (19 +/- 6.6 mm, 12-35 mm) was detected by ERCP in all patients. In total, 101 endoprostheses were implanted endoscopically, exchanged after 3 +/- 2 months, and removed after 10 +/- 8 months. RESULTS: All jaundiced patients showed immediate improvement of cholestasis after drainage. At the time of last exchange or after stent removal, prestenotic CBD dilation was reduced in 55% of all patients. Complete regression of stenosis and prestenotic dilation was accomplished only in 13%; dilation remained unchanged in 10%, and even showed progression in 22%. A total of 29 patients were followed-up over 24 months. Cholestatic parameters remained normal in all patients with complete normalization of the CBD, and were only moderately increased in another 10 patients, 7 and 28 months after stent removal, respectively. CONCLUSIONS: Technical and immediate clinical success of CBD stenting in patients with CBD stenoses due to CP is high; however, long-term complete normalization of the bile duct is rare. Endoscopic drainage of CBD-stenosis in patients with CP can be recommended to alleviate acute cholestasis, but not yet as a definite treatment.

Acute Disease↗