Biomedical subjects
G Lux
Publications and source records attributed to G Lux.
[Control of gastrointestinal motility and secretion by gastrointestinal peptides].
Cyclic pattern of interdigestive motility and of plasma levels of motilin, somatostatin and pancreatic peptide (PP) show close relationship. During interdigestive state gastric and lower esophageal motility seems to be mediated by pulsatile release of motilin, whereas the motor activity of duodenum seems to be controlled by somatostatin. Disturbed interdigestive motility could be demonstrated in gastrointestinal diseases like bacterial overgrowth, sclerodermia, post-vagotomy diarrhea and reflux esophagitis.
[Hemorrhaging esophageal varices--Drug therapy and endoscopic sclerosing of varices].
Acute bleeding from esophageal varices is complicated by a mortality rate of 30-80%, which is reduced by sclerosing therapy to 20-38%. Sclerosing therapy also prevents recurrent bleeds, long-term survival rate seems not to be improved significantly. The decision to shunt procedures after recompensation of liver function is still discussed controversially .
[Palliative endoscopic therapy of esophageal carcinoma].
Endoscopic insertion of esophageal bridging tubes provides palliative therapy in patients with inoperable esophageal carcinoma. Indications are tumor stenoses and esophago-bronchial fistulae. In 138 patients endoscopical application of bridging tubes was performed: 51 esophageal, 42 cardiac and 24 gastric carcinoma, six tumor stenoses caused by bronchial carcinoma and 15 esophago-bronchial fistulae. Letality rate was 8,5%, which is significantly less compared to operative methods. Average survival time of 120 days after implantation seems not to be prolonged despite marked improvement of symptoms, especially of dysphagia.
[Therapeutic strategy in acute pancreatitis (I). Endoscopic possibilities].
Ampullary obstruction due to bile duct stones with consecutive bilio-pancreatic reflux probably plays a major role in the pathogenesis of acute biliary pancreatitis. Because of this presumable pathogenesis endoscopic papillotomy in several clinical studies has proven to be effective. At the Department of Medicine, University of Erlangen-Nürnberg, since 1979 27 patients with suspicion of biliary pancreatitis have been examined by means of ERCP. In 15 patients common bile duct stones could be verified; these patients underwent endoscopic papillotomy. Their clinical course could be influenced favorably. The remaining patients had a temporary bile duct obstruction. Spontaneous stone passage apparently led to a quick reduction of clinical symptoms. The problem of endoscopic papillotomy in biliary pancreatitis is discussed using a patient with gallbladder stones but failure to verify common bile duct stones.
Initial experience with the new electronic endoscope.
With the introduction of an electronic sensor attached to the tip of a flexible endoscope, which functions in the manner of a television camera, new dimensions have been opened up for endoscopy. First reports on the clinical application of this new method have been presented at congresses held recently. We, too, were given the opportunity of trying out the prototype of an electronic colonoscope in four patients. This is a brief report of our findings.
Food-induced histamine release from gastric and duodenal mucosa.
Histamine release from the mucosa of the antrum, corpus and duodenum was induced in-vitro by wheat, egg, milk or fish. For this purpose 18 particles of mucosa were taken from each of 40 patients suffering from various diseases. Simultaneously, blood was drawn for the same procedure and skin tests were performed using the same solutions. A significant release of histamine was objectified in the majority of specimens. The greatest amounts were observed in mucosa of the corpus on incubation with wheat, and in patients with inflammatory diseases. There was, in contrast, no histamine release from blood. Skin tests were negative. Results point to a non-allergic phenomenon rather than an immediate-type hypersensitivity.
[Biliary pancreatitis--diagnostic and therapeutic possibilities with ERCP and endoscopic papillotomy].
The present retrospective study was undertaken to investigate the value of diagnostic procedures--clinical and biochemical parameters, ultra-sonography and ERCP--and the influence of endoscopic papillotomy on the course of biliary pancreatitis in 22 patients. A further 22 patients with alcoholic pancreatitis served as a control group. In the 22 patients with biliary pancreatitis, the case history pointed to biliary disease in 14 cases; in contrast to the patients with alcoholic pancreatitis, in none of these patients did excessive alcohol consumption precede the disease. Seven out of the 22 patients with biliary pancreatitis, but only 2 out of the 22 cases of alcoholic pancreatitis had a previous cholecystectomy. The pain was localized in the right upper abdomen in 60% of the biliary pancreatitis patients, as compared with only 32% of the patients with alcoholic pancreatitis. The laboratory parameters (serum amylases, SGOT, serum bilirubin and leucocytes) did not permit any differentiation between biliary and alcoholic pancreatitis. With respect to the biliary genesis of pancreatitis, the sensitivity of the ultrasound examination was about 68%. The endoscopic detection of a so-called "stone papilla", spontaneous suprapapillary bilio-duodenal fistula, or a blood-tinged papilla, was evidence in favour of a biliary cause of the pancreatitis. In 12 patients, the stones has passed spontaneously; 10 patients were submitted to endoscopic papillotomy for bile duct stones detected by ERCP, and the stones were removed in 9/10 patients. A worsening of the clinical picture by ERCP was not observed in any of the patients. The course of serum amylases, leucocytes and pain in the papillotomied patients corresponded to that in patients with spontaneous stone passage. The results of the present study show that endoscopic papillotomy with stone extraction represents, in most patients with biliary pancreatitis, a possibility for causal therapy, avoiding an emergency surgical intervention. In demonstrated cholecystolithiasis, cholecystectomy can be planned as an elective procedure.
[The irritable colon].
Gut dysfunction can be demonstrated in 20-30% of normal adults without ever developing real illness. Irritable bowel syndrome is not merely a gastrointestinal disturbance, but involves the whole organism. With respect to etiology a number of factors such as constitution, mental state and environment, colonic motility, gastrointestinal peptides, low residue diet, food intolerance and infections all seem to play a role. Positive diagnosis by electromyography has not gained any clinical relevance. Treatment of gastrointestinal functional disorders is characterized by a considerable positive response to placebo and is oriented towards individual symptoms. Bran and bulking agents are effective when constipation is present, opiate-agonists have a positive influence in diarrhoea, anti-cholinergics may be of some value in abdominal pain, antidepressants and sedatives given for a limited period of time may be beneficial in psychiatric symptoms. The combination most often used in therapy of irritable bowel syndrome consists of sedatives, anticholinergics and bulking agents. Psychotherapy can prolong the positive effects of medical therapy even beyond the treatment period. Long-term follow-up reveals a satisfactory response of the symptomatology in the majority of patients.
Ultrasound tomography of the upper gastrointestinal tract. Orientation and diagnostic possibilities.
40 patients were examined by peroral endoscopic ultrasonography with two new prototypes (Prototype II and III, Olympus Optical Co., Tokyo, Japan). Indications were given by various intestinal diseases. Topographical orientation could be difficult, but was facilitated by standard positions of the instrument. The organs identified included liver, gallbladder, common bile duct, pancreas, spleen and kidneys. Pathological lesions of the mentioned organs were characterized by the reflex pattern known from external ultrasonography. Up till now endoscopic sonography is not a routine method but may give additional information to peroral endoscopy and external ultrasonography without replacing these methods.
Initial results of transgastric endoscopic ultrasonography in comparison with external ultrasound.
Endoscopic ultrasonography was developed in an attempt to utilize the improved resolution of small-parts ultrasonography also in the investigation of organs located deep within the body as opposed to at the surface. A further expected advantage vis-à-vis external ultrasonography was the avoidance of the frequently obstructing air. In an initial study of 40 patients with a variety of different diseases of the upper abdomen, we were indeed able to utilize the advantages described, with the result that diagnostic information was obtained that neither external ultrasound nor endoscopy was able to provide. A limitation of endoscopic ultrasonography is the fact that the "path" of the transducer is predetermined by the course of the gastrointestinal tract. A further difficulty is the anatomic orientation. To combat this latter problem, our working group has under X-ray control, established standard position for the ultrasound endoscope.
[Retained cholelithiasis--a risk factor after endoscopic papillotomy?].
Endoscopic papillotomy (EPT) today is in well defined indications an accepted procedure for the therapy of common bile duct stones. In patients with stone gallbladder in situ and bile duct stones it has been recommended to remove the gallbladder after papillotomy in order to prevent late complications. The present study shows that the gallbladder in situ is not necessarily a significant risk factor. On an average of 34,9 months (16-84) after EPT of 223 patients with a follow up, 83,7% were free of symptoms or significantly improved. Cholecystectomy was performed in 43 patients (18,9%): in 24 (11,6%) within an interval , in 13 (6,3%) as an emergency operation following a complication of EPT and in 2 (1%) months later because of recurrent cholecystitis. In patients over 70 years of age with increased risk for surgery therefore a gallbladder with stones after EPT must not absolutely be removed. A wait and see attitude may be justified.
[Early detection of pancreatic diseases. Practical consequences].
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[Gastrointestinal tuberculosis--a diagnostic challenge].
Gastrointestinal tuberculosis has become a rare disease. Lesions are predominantly located in the ileocecal region, but all parts of intestinum can be involved. Occurrence in the esophagus is very rare. Protean manifestations often prevent an accurate diagnosis on time, especially if pulmonary symptoms are absent or misjudged. The further clinical course is determined by late complications of tuberculosis. We present 3 cases of gastrointestinal tuberculosis (two of esophagus, one of ileocecal region) in order to remind of this rare disease, which is associated with so many pitfalls.
[Ultrasound diagnosis via the gastroscope].
Eighty patients presenting with various diseases of the upper abdominal organs were investigated in an initial series of examinations performed with an ultrasonic endoscope provided with a mechanical sector scanner (7.5 MHz rated frequency, sector selectable between 90 degrees and 180 degrees), and/or a linear array device (7.0 MHz rated frequency, field of view 31 mm). Orientation, which was initially difficult, was facilitated by establishing standard positions. The pancreas, liver, gallbladder, bile duct, spleen, the two kidneys, the vessels of the upper abdomen, the wall of the stomach and, of course, the heart, are all accessible to endoscopic diagnostic ultrasound. At the present state of our knowledge, the method does not appear suitable for the systematic diagnostic work-up of the upper abdominal organs, but in certain cases it would seem to be a useful supplementary examination to external ultrasonography or endoscopy.
The importance of ERCP for the surgical tactic in haemorrhagic necrotizing pancreatitis (preliminary report).
In patients with haemorrhagic necrotizing pancreatitis who are scheduled for surgery, we have been carrying out a preoperative retrograde investigation of the pancreatic duct system for the past 3 months. The results in, to date, ten patients, all of whom survived their severe illness, revealed four different morphological findings of importance for the surgical tactic. 1. A normal pancreatic duct system with no signs of fistulae: only peripancreatic necrosectomy is required. 2. Contrast medium leaks via a ductal fistula: left resection, including the removal of the fistulous area, must be done. 3. Normal duct system with complete segmental parenchymal staining, representing total necrosis in this region: left resection of the pancreas. 4. Duodenoscopically demonstrable perforation into the duodenum of a necrotic cavity in the head of the pancreas: conservative management only, no surgery, since this lesions, resulting in drainage of the necrotic cavity into the bowel, permits self-healing, while the site of the perforation within the necrotic wall cannot be dealt with by surgery. The experience gained so far indicates that the surgical tactic can be determined with greater selectivity by the use of ERCP.
The value of emergency endoscopy in upper gastrointestinal bleeding: review and analysis of 2014 cases.
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