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Biomedical subjects

H Seifert

Publications and source records attributed to H Seifert.

At least 91 records · Page 5Linked to original sources
PubMed1997

Sonographic detection of focal changes in the liver hilus in patients receiving corticosteroid therapy.

OBJECTIVE: While diffuse deposition of fat may occur with corticosteroid (CS) administration both in the liver and in other organs, comparatively little is known about focal changes in the liver under corticosteroid medication. Therefore, we evaluated pattern and extent of focal hepatic steatosis by ultrasound (US) in patients receiving corticosteroids. SUBJECTS AND METHODS: 93 patients with known inflammatory bowel disease (IBD) received corticosteroids during a period of at least six weeks prior to the ultrasound examination and 28 IBD-patients had no corticosteroids within the last three years. 13 additional patients received corticosteroids for other reasons than IBD for > 1 year. 80 healthy volunteers served as controls. Focal changes of the liver as assessed by high resolution ultrasound (Acuson 128, 3.5 and 5 MHz) were defined as areas of brighter echogenicity compared to the general aspect of the liver. The size of the hyperechoic areas was documented (photoprint). RESULTS: 40/93 IBD-patients with corticosteroids (43%) had definite areas of brighter echos in the hilus region of the liver. In IBD-patients without corticosteroids only one patient showed a focal brighter echogenicity, whereas in the non-IBD group with corticosteroids 8/13 had focal lesions (62%). In the control group only four healthy subjects showed brighter areas (5%). CONCLUSION: Bright focal areas in the liver hilus occur in > 40% of IBD-patients during corticosteroid medication. This phenomenon occurs in IBD-patients as frequently and as intense as in other patients with longstanding corticosteroid therapy. There is a hilar area of the liver with typical size and location which reacts to corticosteroid administration with hyperechoic reflexes at ultrasound investigation. This is important to know when it comes to the differential diagnosis of focal changes.

Adrenal Cortex Hormones↗
PubMed1996

Papillary roof incision using the Erlangen-type pre-cut papillotome to achieve selective bile duct cannulation.

BACKGROUND: Prior studies evaluating pre-cutting the major papilla to access the bile duct when standard cannulation falls have usually used the needle-knife papillotome. We conducted a prospective study to evaluate the efficacy and safety of an Erlangen-type pre-cut papillotome for pre-cutting. PATIENTS AND METHODS: Three hundred twenty-seven patients (114 men, mean age 67 years) who underwent first-time sphincterotomy at our institution were included. Pre-cutting was performed if free and wire-guided cannulation of the bile duct failed according to an algorithm. RESULTS: Pre-cutting was performed in 123 patients (38%) and selective cannulation was successful in all. Post-ERCP serum pancreatic enzyme levels were more frequently elevated in the pre-cut group (50%) than the non-pre-cut group (27%, p < 0.001); however, there was no difference in the incidence of post-ERCP pancreatitis (pre-cut = 2.7%, 95% CI: 0.66% to 7.6%; non-pre-cut = 1.6%, 95% CI: 0.3% to 4.7%). The incidence of bleeding was similar (pre-cut, 2.4%, non-pre-cut, 3.9%; p > 0.05). CONCLUSION: Pre-cutting the major papilla for biliary access using the Erlangen-type pre-cut papillotome is an effective and reasonably safe procedure when performed by endoscopists with extensive experience in pancreatobiliary endoscopy.

Aged↗
PubMed1996

Endoscopic snare excision of "giant" colorectal polyps.

BACKGROUND: Endoscopic treatment of giant colorectal polyps remains controversial because of concerns regarding coexistent malignancy, incomplete resection, and safety. METHODS: We reviewed the clinical course after removal of 176 benign-appearing large (>3 cm) colorectal polyps, which were removed by endoscopic snare resection in 170 patients. These were termed "giant" polyps. Sessile polyps (n = 129) were removed piecemeal and pedunculated polyps (n = 47) transected at the stalk. RESULTS: Bleeding was the only complication in 24% of polypectomy procedures (procedural in 58, immediate in 3, delayed in 6 patients). Except for one conservatively treated delayed bleed, all bleeds were treated endoscopically. Histology of resected polyps showed coexistent malignancy in 12%. Eight patients had malignant polyps that met "unfavorable" criteria and underwent surgery. Following complete endoscopic resection, 16 patients were lost to follow-up and 124 patients had follow-up of at least 6 months (117 benign and 7 "favorable" malignant polyps). Nineteen patients with benign polyps developed recurrences (18 benign, 1 malignant); one patient with a favorable malignant polyp had a malignant recurrence and underwent surgery. CONCLUSION: Endoscopic resection of benign-appearing giant colorectal polyps is feasible and safe. Complete excision is possible in patients with benign and favorable malignant polyps, but recurrence rates are high. Close surveillance to detect and treat recurrence is required.

Adolescent↗
PubMed1996

Empirical liposomal amphotericin-B therapy in a neutropenic patient: breakthrough of disseminated Blastoschizomyces capitatus infection.

Blastoschizomyces capitatus (Trichosporon capitatum) is an uncommon fungal pathogen. Infections have mostly been seen in immunocompromised patients and use of broad spectrum antibiotics was identified as a risk factor. Treatment has been extremely difficult. A report is presented about a case of fatal B. capitatum infection with clinical septicemia and multiorgan failure during intravenous liposomal amphotericin B therapy.

Adult↗
PubMed1996

[Mini-probe ultrasound of the upper gastrointestinal tract--1995 state of the art and perspectives. Workshop on Mini-Probe Ultrasound in Gastroenterology, Münster, 28 October 1995].

Endoscopic ultrasound (EUS) allows for intraluminal sonographic imaging of the oesophagus, stomach, pancreatobiliary duct system, the papilla of Vater, as well as the colon and rectum. EUS has proved valuable for diagnosis and staging of tumours of the upper intestinal tract. EUS can also provide valuable additional information concerning lesions that cannot be immediately classified. As doing this involves, first, removal of the conventional endoscope and, second, insertion of the echo endoscope, EUS is not suitable for routine examinations. Therefore EUS has remained an independent endoscopic diagnostic modality. Moreover, due to their diameter conventional echoendoscopes cannot be inserted into the pancreatobiliary duct system. Fine calibre high frequency ultrasound probes promise a resolution of less than 2 mm in diameter. The following report is a summary of a one-day workshop which took place in Muenster, Germany on Oct. 28, 1995. Its goal was to define the current state of the art of miniaturised endoscopic ultrasound probes in the field of gastroenterology. During this workshop, possible clinical applications for diagnosis, therapy, as well as follow-up were described and discussed. The potential of miniaturised endoscopic ultrasound probes was explored in terms of possible future technical developments.

Endoscopy, Gastrointestinal↗
PubMed1996

A new guide wire papillotome for patients with Billroth II gastrectomy.

BACKGROUND AND STUDY AIMS: Guide wire-assisted papillotomy is a well-established technique in conventional biliary endoscopy, but has not been previously employed in Billroth II patients, due to the lack of an appropriate papillotome that can accommodate a guide wire. We therefore designed a Billroth II papillotome that can be inserted over a guide wire. PATIENTS AND METHODS: Over a 12-month period, 24 patients (18 males, six females, median age 72 years), who had previously undergone a Billroth II gastrectomy and who were referred to our department for therapeutic biliary endoscopic procedures, were included in this study. RESULTS: The papilla could be reached in 22 patients, but the procedure failed in two due to an excessively long afferent loop. Cannulation of the bile duct with the standard Billroth II papillotome was possible in 11 patients; the remaining 11 patients, in whom free cannulation failed, underwent cannulation over the guide wire. Diagnostic endoscopic retrograde cholangiography revealed bile duct stones in 17 patients, and malignant-appearing common bile duct stenoses in five patients. Papillotomy was successfully performed using the guide wire Billroth II papillotome in all patients, without complications. CONCLUSION: The Billroth II papillotome is effective and safe in patients in whom free cannulation has failed using the standard Billroth II papillotome.

Aged↗
PubMed1996

[Radiation exposure in abdominal radiography with digital luminescence radiography and conventional screen-film system: an experimental animal study].

PURPOSE: To determine and compare the minimum required radiation exposure for a.-p. abdominal radiographs with digital luminescence radiography (DLR) and a screen-film system (SFS) providing adequate image quality in clinical routine. MATERIAL AND METHOD: Abdominal radiographs a.-p. of a pig were produced with DLR and SFS systematically varying the tube current-time product. The image quality was assessed by eight experienced radiologists according to the criteria of visual resolution, mean optical density, perceptibility of the lateral edge of the psoas, the caudal edge of the liver, bone structures and intestinal wall. RESULTS: The image quality of the digital radiographs was better for each criterion except visual resolution if the same current-time product was used for both techniques. From the minimum tube current-time products providing an adequate image quality it follows that a dose reduction of 57% can be achieved by applying DLR instead of speed class 200 SFS. CONCLUSION: The recently published guide-lines for quality assurance in x-ray diagnostics issued by the German Federal Board of Physicians recommend using speed class 400 SFS. Since in that case an approximately halved radiation dose is necessary, dose reduction is hardly to be expected with DLR.

Animals↗
PubMed1996

A study of dose reduction using digital luminescence radiography for lateral skull radiography.

For lateral skull radiography the minimum required radiation patient exposure to ensure adequate image quality was determined for digital luminescence radiography (DLR) in comparison with a screen-film system (speed class 200). Radiographs were produced with a grid technique on conventional X-ray equipment. A real prepared female head including a true fracture above the pars petrosa ossis temporalis was imaged. The tube current-time product (mAs), and thus the surface entrance dose, was varied systematically. Surface entrance dose was measured with TLD-100 rods. Image quality was judged by experienced radiologists according to the criteria: visual resolution, mean optical density, contrast and perceptibility of specific bone structures. Surface entrance dose was reduced from 0.46 to 0.20 mGy by application of DLR instead of speed class 200 screen-film system without loss of diagnostic information in clinical routine. This corresponds to a dose reduction potential of 57% showing a good agreement with the dose reduction potential of 52% obtained in a previous study using the Alderson head phantom.

Female↗
PubMed1995

Clinical and bacteriological features of relapsing shunt-associated meningitis due to Acinetobacter baumannii.

A case is reported of a patient who developed Acinetobacter baumannii meningitis ten days after a ventriculoperitoneal shunt had been placed for control of elevated intracranial pressure. Intravenous antimicrobial therapy was instituted with imipenem and tobramycin after shunt removal and insertion of a ventriculostomy tube. Following the placement of a ventriculoatrial shunt, clinical and microbiological relapse occurred that was eventually cured after complete removal of the ventricular drainage system and a second course of systemic antibiotics. Relapse was confirmed by modern molecular typing techniques including plasmid DNA fingerprinting and analysis of total genomic DNA by pulsed-field gel electrophoresis.

Acinetobacter↗
PubMed1995

Transpapillary and transmural drainage of pancreatic pseudocysts.

BACKGROUND: Endoscopic drainage of pseudocysts using the transpapillary and transmural approaches has been reported. We evaluated endoscopic drainage in 53 patients with symptomatic pancreatic pseudocysts in whom conservative management had failed. METHODS: After preliminary endoscopic retrograde pancreatography, transpapillary drainage was attempted in 33 patients with pseudocysts that communicated with the main pancreatic duct. Transmural drainage of pseudocysts in contact with the stomach or duodenal wall was attempted in the remaining 20 patients and in 4 patients selected for combined transpapillary and transmural drainage. The cause of pseudocysts was chronic pancreatitis in 92%. The median pseudocyst size was 7.0 cm (range, 2 to 16). RESULTS: Endoscopic drainage was technically successful in 50 patients (94%), of whom 47 had complete pseudocyst resolution. Complications occurred in 11% and included gallbladder puncture (n = 1) and bleeding (n = 2) after transmural drainage, and pancreatitis (n = 1) after transpapillary drainage; stent clogging resulted in abscess formation in 2 patients. Mean follow-up was 22 months (range, 1 to 70); pseudocysts recurred in 11 patients (23%), of whom 7 were successfully re-treated endoscopically. CONCLUSION: Both transpapillary and transmural pseudocyst drainage are highly effective in patients with pseudocysts demonstrating suitable anatomy for these endoscopic techniques.

Adult↗
PubMed1995

Ultrasonic esophagoprobe for TNM staging of highly stenosing esophageal carcinoma.

BACKGROUND: Endosonographic staging of esophageal carcinoma may be limited in one third of cases by tumor stenoses that cannot be traversed with conventional echoendoscopes. We designed and evaluated a new endosonographic instrument (ultrasonic esophagoprobe) for TNM staging of highly stenosing esophageal carcinomas. METHODS: Eighty-seven consecutive patients (64 men, mean age 61 years) with highly stenosing esophageal carcinomas were studied with the esophagoprobe (features: diameter of 7.9 mm, bougie-shaped tip, no fiber optics, insertion over a guide wire). RESULTS: The esophagoprobe was successfully inserted past the stenosis without complication in all patients. Nine patients (10%) required preliminary bougienage to 33 F. The imaging quality was high and allowed for complete T and N staging in all patients. M staging was indeterminate in 15 patients because of inadequate visualization of the celiac axis region. Histopathologic correlation in 38 patients who underwent surgery showed an overall T stage accuracy rate of 89% (T2 = 80%, T3 = 95%, T4 = 87%), and N and M stage accuracies of 79% (N0 = 44%, N1 = 90%) and 91% (M0 = 94%, M1 = 75%), respectively. CONCLUSIONS: The esophagoprobe enables safe passage of highly stenosing esophageal carcinomas for TNM staging. Accuracy rates are similar to those reported for conventional echoendoscopes.

Adult↗
PubMed1995

Acinetobacter species as a cause of catheter-related infections.

In recent years, Acinetobacter species have emerged as clinically important pathogens. Though these organisms are widely prevalent in nature, most human infections are hospital-acquired. Acinetobacter baumannii is the predominant species. Nosocomial Acinetobacter baumannii infections such as respiratory tract infections, urinary tract infections, meningitis following neurosurgical procedures, and bacteremia mainly affect patients with severe underlying disease in the ICU and often, in the setting of nosocomial outbreak. The occurrence of multiresistant strains often limits therapeutic options. A substantial part of Acinetobacter baumannii bacteremia cases represent catheter-related infections that usually carry a favorable prognosis. Acinetobacter species other than Acinetobacter baumannii are less frequently reported as a cause of infection in humans. Bacteremia due to these organisms is mostly sporadic and almost exclusively related to intravascular devices. The underlying diseases are often less severe than those of patients affected by Acinetobacter baumannii infections. The clinical course is usually benign and the infection responds readily to catheter removal irrespective of the appropriateness of antimicrobial therapy.

Acinetobacter↗
PubMed1995

Comparative classification of Acinetobacter baumannii strains using seven different typing methods.

A group of 49 Acinetobacter baumannii strains obtained from several hospital outbreaks and some sporadic cases were typed by biotyping, antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), plasmid typing, multilocus enzyme electrophoresis, whole-cell protein profile, and Fourier-transform infrared (FT-IR) spectroscopy. All these methods have shown a high degree of reproducibility and are capable of recognising strains from the same epidemiological event. However, their power to discriminate between epidemiologically unrelated strains varies, with PFGE being superior to the other methods investigated. FT-IR spectroscopy, which has not yet been used for typing of Acinetobacter strains, proved to be a very rapid and highly reproducible method, but was somewhat limited in its discriminating power.

Acinetobacter↗
PubMed1995

Micrococcus luteus endocarditis: case report and review of the literature.

This paper includes a report on a case of prosthetic valve endocarditis due to Micrococcus luteus and a review of the sixteen cases of endocarditis due to Micrococcus species reported in the literature. The patient was successfully treated with rifampicin combined for two weeks with gentamicin and vancomycin and for another four weeks with teicoplanin. The hospital course was uneventful and no surgery was required.

Aged↗
PubMed1995

Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture: long-term results.

BACKGROUND AND STUDY AIMS: Endoscopic pancreatic stent drainage has been reported to relieve pain due to chronic pancreatitis in patients with ductal outflow obstruction. However, data regarding the long-term results, as presented here, have hitherto been lacking. PATIENTS AND METHODS: Over a nine-year period, 93 patients (65 males, mean age 49 years) with narcotic-dependent pain due to chronic pancreatitis and with a dominant pancreatic duct stricture visualized by endoscopic retrograde cholangiopancreatography (ERCP), were treated by stent drainage. The duration of pain prior to treatment averaged 5.6 years. The stents were exchanged according to symptoms, and removed if the stricture was judged to be adequately dilated after stenting. RESULTS: Sixty-nine patients (74%) reported complete (n = 46) or partial (n = 23) pain relief at six months. In this group of "early responders", 60 patients experienced sustained improvement during a mean follow-up of 4.9 years (nine had recurrent pain after a mean of 1.2 years). Stents were removed in 49 patients after a mean of 15.7 months; during a mean follow-up of 3.8 years, 36 patients remained pain-free, and 13 had a relapse of pain (11 were retreated by endoscopic drainage and subsequently became pain-free). Complications seen included mild pancreatitis (n = 4) and abscess formation secondary to stent clogging (n = 2). Most patients experienced a regression of the ductal dilation after stenting. CONCLUSION: In selected patients, early responders to pancreatic stent drainage are likely to benefit over the long term. Stent removal after stricture dilation may be associated with continued pain relief.

Adult↗
PubMed1995

Nosocomial bacteremia due to Acinetobacter baumannii. Clinical features, epidemiology, and predictors of mortality.

To study the possible predisposing factors, clinical features, molecular epidemiology, and factors affecting mortality associated with bacteremia due to Acinetobacter baumannii, we reviewed 87 episodes of A. baumannii bacteremia occurring in 79 patients hospitalized at 2 university tertiary care centers and 4 community-based hospitals during a recent 18-month period. Plasmid DNA analysis and analysis of genomic DNA with pulsed-field gel electrophoresis was performed to investigate possible epidemiologic relationship. All patients acquired their infections in the hospital, and no seasonal variation was observed. Among patients with A. baumannii bacteremia, 91% were hospitalized in an intensive care unit, 99% had indwelling vascular catheters, 81% received prior broad spectrum antimicrobial therapy, 70% were mechanically ventilated, and 47% had major surgical procedures. In 39 cases (45%) the infection was related to indwelling vascular access devices. Other infections included pneumonia (9%), tracheobronchitis (22%), meningitis (2%), and burn wound infections (4%). Septic shock occurred in 30% of patients. All isolates were multidrug resistant. Polymicrobial bacteremia was observed in 35% of cases. The crude mortality rate was 44%. Death was considered attributable to A. baumannii bacteremia in 15 (19%) patients. All patients with pneumonia as the primary site of infection died. Using multivariate analysis, we identified 3 independent predictors of mortality: the presence of a rapidly or ultimately fatal underlying disease (p = 0.0009), septic shock at the onset of bacteremia (p = 0.0013), and mechanical ventilation (p = 0.016). Epidemiologic typing revealed that 82 episodes were associated with different hospital outbreaks of infection, and only 7 episodes were due to epidemiologically unrelated strains.

Acinetobacter Infections↗
PubMed1995

Comparison of ribotyping and pulsed-field gel electrophoresis for molecular typing of Acinetobacter isolates.

Seventy-three isolates of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex, including 26 isolates from 10 hospital outbreaks, were typed by ribotyping with EcoRI and ClaI and by pulsed-field gel electrophoresis (PFGE) of genomic DNA after digestion with ApaI. Ribotyping with EcoRI distinguished 31 ribopatterns. Digestion with ClaI generated another eight ribotypes. PFGE, in contrast, identified 49 distinct patterns with seven variants. Both methods detected all outbreak-related isolates. By ribotyping, nine epidemiologically unrelated strains could not be differentiated from outbreak strains, in contrast to only one isolate not identified by PFGE. Thus, PFGE was more discriminating than ribotyping. However, ribotyping is known to generate banding patterns specific to each DNA group in the A. calcoaceticus-A. baumannii complex that may be used for taxonomic identification of the strains. PFGE was shown to lack this property. Both methods are therefore useful for strain differentiation in epidemiological studies of Acinetobacter isolates.

Acinetobacter↗