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Biomedical subjects

C Ell

Publications and source records attributed to C Ell.

At least 127 records · Page 7Linked to original sources
PubMed1994

[Current use of lasers in gastroenterology].

The main indications for laser therapy in the gastrointestinal tract are inoperable tumors of the esophagus, cardia and the recto-sigmoid. Exophytic tumors with a maximum length of the tumor stenoses between 5 and 7 cm are the best candidates for laser treatment. In gastroenterological stone centers, the laser-induced intracorporeal shock wave lithotripsy is now established. The sophisticated principle of the so-called photodynamic therapy is still in an experimental stage. Photodynamic therapy offers the option of curative therapy in small malignant or premalignant (Barrett esophagus with severe dysplasia) lesions.

Cholelithiasis↗
PubMed1994

[Conservative and interventional therapy of chronic pancreatitis].

In chronic pancreatitis high-dose enzyme therapy is only indicated if an insufficiency of the exocrine gland exists. For pain conventional analgesics such as Paracetamol, Metamizol or Tramadol are indicated. In case of pancreolithiasis, ESWL is the method of choice. This treatment should be combined with papillotomy of the pancreatic sphincter to achieve a good access to the duct system. If strictures are seen during ERCP, balloon dilatation and consecutive implantation of a plastic prosthesis are necessary to permit regular flow of pancreatic juice. Stent-clogging is the main problem of drainage-procedures. Regular exchange of the stent is mandatory. Pseudocysts should be drained via the papilla if there is a connection between the cyst and the duct system. All others should be drained endoscopically, by puncturing the cyst through the gastric or duodenal wall, or percutaneously. Surgical procedures should be delayed whenever possible, since surgical treatment is invasive (e.g. Whipple's operation) and the long-term prognosis is poor.

Calculi↗
PubMed1994

[Cost comparison of laparoscopic cholecystectomy and extracorporeal shockwave lithotripsy in the treatment of gallstones].

To aid in the choice between laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy for the treatment of gallstones the costs of the two methods were investigated. A decision tree was constructed so as to set out the initial procedure costs of both techniques and possible subsequent costs due to treatment failure or complications. The computations were based on figures from the University Clinic, Erlangen, in 1993. The direct (medical) costs of laparoscopic cholecystectomy amounted to DM 3556, to which must be added further indirect costs of DM 3152 arising from loss of working capacity and premature death. The direct expenses for lithotripsy including outpatient aftercare were DM 6708 and the indirect expenses DM 1858. The overall costs per patient for lithotripsy are hence DM 1858 higher than those of laparoscopic cholecystectomy. This cost difference remained substantially unaltered even when the success rates of the two techniques were varied over a wide range. When lithotripsy is performed entirely as an outpatient procedure and inpatient costs hence disappear, the expected overall cost drops from DM 8567 to DM 6381. Omission of the lump sum charge for lithotripsy effects a similar drop in overall costs to DM 6379. Laparoscopic cholecystectomy is hence cheaper than lithotripsy. Only if lithotripsy can be performed at very low cost can it compete with laparoscopic cholecystectomy.

Aftercare↗
PubMed1994

[Presacral phlegmons and meningitis as the complications of a foreign body in the rectosigmoid].

A 24-year-old patient presented with severe back pain in the lumbar and sacral regions and septic temperatures up to 40 degrees C. Lasègue's sign was bilaterally positive. An enhanced cell count was seen in the CSF (1877 cells/microliters, erythrocytes 1024/microliters). Total protein concentration was 4440 mg/dl. The patient also suffered from granulocytic pleocytosis. X-ray as well as scintigrams revealed inflammation of the presacral soft parts involving the os sacrum and bone marrow. Treatment with doxycycline (200 mg/d), fosfomycin (5 g/d), netilmicin (400 mg/d) and ofloxacin (200 mg/d) succeeded in curing the meningitis, whereas the presacral phlegmon persisted. Endoscopic examination showed a rod-shaped foreign body in the rectum that had penetrated deeply into the mucosa and required deformation and removal by laser. The plastic rod of 10 cm length was probably a liquorice stick. The patient denied introducing it per anum; he suspected having swallowed it while drunk. The inflammation subsided rapidly after removal of the foreign body.

Adult↗
PubMed1994

[Photodynamic therapy of a gastric stump carcinoma with curative intent. The first case report of a clinical application in Germany].

Photodynamic treatment (PDT) of malignant tumours rests on the intravenous administration of a photosensitizer, which is predominantly in tumour tissue, and subsequent activation of this substance with light of a specific wavelength. The method was used in a 76-year-old man who had undergone a 2/3 gastric resection for ulcer in 1948 and was now found to have a carcinoma of the stump at the anastomosis. He refused surgical resection, but accepted PDT. 48 hours after intravenous administration of the photosensitizer dihematoporphyrin ether-ester (2 mg/kg) the 1.5 x 1.0 cm tumour was irradiated with an argon ion laser pumped colour laser system at a wavelength of 630 nm and energy density of 150 J/cm3. The irradiation was performed under endoscopic control via a specially developed applicator which had first been introduced through the biopsy channel of the endoscope. Four weeks after the first treatment biopsies from a 5 mm ulceration in the area of the tumour revealed malignant cell groups, so that a second treatment was undertaken. Two, three and six months later the ulcer was shown to have healed and biopsies were free of tumour. But nine months later tumour cells were again demonstrated and a third PDT was performed. Although biopsies were again free of tumour at the next control, it can not yet be assumed that the tumour has been cured.

Aged↗
PubMed1994

Coated and uncoated self-expanding metal stents for malignant stenosis in the upper GI tract: preliminary clinical experiences with Wallstents.

OBJECTIVES: The clinical feasibility of self-expanding metal stents with respect to the technical success, complications, and reintervention rate should be tested. METHODS: Five coated and 26 uncoated prototype Wallstents, especially designed for stenosis of the upper GI tract, were implanted in 23 patients. All patients with dysphagia suffered from inoperable tumor stenosis of the esophagus or the cardia. Stent implantation was performed under slight i.v. sedoanalgesia. RESULTS: Technical success was achieved in all 31 implanted stents. Forty-eight hr after implantation, dysphagia was improved in 21/23 patients. Acute problems observed within 1 wk were stent migration (1 patient, uncoated stent), oblique position of the stent (3 patients), epigastric or retrosternal pain (9 patients), insufficient stent expansion (4 patients), and pouch formation at the upper rim of the stent (4 patients). An uncomplicated follow-up (median 66 days, range 10-139 days) was seen in 12 patients (52%). Major problems in the follow-up period were stent migration in three patients (three coated stents, two stent migrations in one patient) and stent obstruction by tumor ingrowth/overgrowth and/or food impaction in eight patients (35%). Most of these problems could be successfully resolved by implantation of a second stent or electrocoagulation of overgrowing tumor tissue. By the 1st of March, 1994, three patients were still alive with a follow-up period of 530 days (median range, 336-880 days); 20 patients were decreased with a follow-up period of 70 days (median range, 3-374 days). CONCLUSIONS: Implantation of esophageal Wallstents is safe and has a low risk of acute complications and mortality for the patient. Early complications such as perforation and bleeding did not occur. Tumor ingrowth/overgrowth are the major reasons for the high reintervention rate in the follow-up period. Coated stents can resolve this problem, provided that stent migration can be avoided by improvement of the coating technology.

Adenocarcinoma↗
PubMed1994

[Radiation burden in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP)].

UNLABELLED: The increasing expansion of diagnostic and, in particular, of therapeutic ERCP calls for greater consideration of the radiation dose to which the investigator and assistant personal are exposed and emphasizes the question of additional radiation protection measures such as leadshielded glasses and thyroid protection. MATERIALS AND METHODS: Local radiation doses were measured in 19 ERCP sessions at head level of the endoscopist, assistant staff and the radiologist, respectively. The fluoroscopic time, the area dose product (ADP) and the measuring height were recorded. A quotient based on the measured local dose and the ADP was formed which includes all variables having an effect on the scattered radiation. Using this quotient and the known ADP-values radiation exposure levels were mapped over a period of three months and then extrapolated to obtain the annual dose. RESULTS: Not only the FT, but also the ADP, the measuring height, and the source-image-distance (SID) are found to influence the magnitude of the radiation dose to which the investigator and his assistants are exposed at head level. For an assumed rate of 1200 ERCPs per year a median radiation at head level of 16.5 mSv/a is calculated for the investigator, and a corresponding head-level dose of 5.5 mSv/a for the assistants. This shows that the eye dose to which the investigator (and his assistants) are exposed amounts to 10% (5%) and the thyroid dose to 5% (1.5%) of the legally prescribed limit dose. If fewer ERCPs are performed, or if the investigations are divided up among several doctors and assistants, radiation exposure is reduced accordingly. CONCLUSIONS: Under the prevailing investigation conditions additional radiation protection measures such as leadshielded safety glasses or thyroid protection do not appear necessary.

Body Burden↗
PubMed1994

Piezoelectric shock wave lithotripsy of pancreatic duct stones.

OBJECTIVES: The efficacy of extracorporeal piezoelectric shock wave lithotripsy in patients with obstructing pancreatic duct stones was investigated. METHODS: Fifty patients suffering from chronic pancreatitis and obstructing pancreatolithiasis were treated by ESWL (Piezolith 2500). Shock wave treatment was administered, inasmuch as the stones were not extractable by initially applied endoscopic measures. RESULTS: A total of 119 (2.4 +/- 1.4, range 1-7) lithotripsy sessions were conducted; only mild sedation/analgesia was used. Optimum targeting of the concrements in the shock wave focus was achieved in 17 (14%) treatment sessions with ultrasonography only; it was achieved in 65 (55%) cases by fluoroscopy and, in further 37 (31%) sessions by using both localization systems. Stone fragmentation was successful in 43 (86%) patients. Nineteen (38%) patients achieved spontaneous stone discharge after shock wave lithotripsy. In 11 (22%) cases, it was possible to remove all fragments endoscopically; residual fragments remained in 20 (40%) patients. Severe complications attributable to shock wave application did not occur. During follow-up, six patients had to be referred to surgery; two male patients died of specific diabetic complications and pleural mesothelioma, respectively. Thirty-five (90%) of 39 patients whose conditions were followed for 2-50 (20 +/- 14) months reported improvement of their pain sensations. Six (15%) patients required endoscopic treatment, including ESWL in five of those patients, to be repeated due to recurrent formation of calculi in the main pancreatic duct, which was again successful in five of the six patients. CONCLUSIONS: Piezoelectric shock wave lithotripsy offers a basis for safe and effective fragmentation of pancreatic stones and facilitates endoscopic procedures. Most of the patients with obstructing pancreatic stones became stonefree and showed a significant reduction of pain.

Calculi↗
PubMed1993

[Liver hemangiomatosis in Osler's disease].

Heart failure occurred in a 50-year-old woman as a result of calcified haemangiomatosis of the liver with a high shunt volume. In the subsequent years there were several bleedings from peptic ulcers. Ultrasonography revealed an increase in liver size and the previously diagnosed calcification. 14 years later the patient was again hospitalized because of increasing weakness and stress dyspnoea; the haemoglobin level was 5.5 g/dl. In addition to the florid gastric and duodenal ulcers, angiodysplasias were for the first time demonstrated in the stomach, duodenum and sigmoid colon, as were telangiectasias in the face and echo-dense round foci in the spleen. After transfusion of red cell concentrates and healing of the peptic ulcers under a 14-day treatment with omeprazole (20 mg two times daily by mouth) and amoxycillin (750 mg three times daily by mouth) the haemoglobin level increased at first (10 g/dl), then tarry stools were once again noted. The condition stabilized after laser coagulation of all accessible gastrointestinal angiodysplasias. The isolated calcified hepatic haemangiomatosis, diagnosed 14 years previously, is most likely a rare variant of hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease).

Calcinosis↗