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J F Riemann

Publications and source records attributed to J F Riemann.

At least 19 recordsLinked to original sources
PubMed2006

[Patient acceptance of magnetic resonance colonography: a prospective inquiry for comparison to conventional colonoscopy].

BACKGROUND AND OBJECTIVE: Precondition for establishment of magnetic resonance colonography (MRCG) as a diagnostic tool in secondary prevention of colorectal cancer is not only high diagnostic accuracy but also a good acceptance amongst patients. The aim of this study was to compare post-examination appraisal of patients for MRCG to that of bowel preparation and conventional colonoscopy. PATIENTS AND METHODS: 88 patients (24 women, 64 men, mean age 67 +- 17,3 years) were interviewed by a standardized questionnaire regarding pain/discomfort (scale from 1 to 10), overall assessment of difficulties and preference for future tests. After bowel cleansing, MRCG and conventional colonoscopy were performed on the same day. Bowel cleansing consisted of drinking about 5 liters of a polyethylene glycol-electrolyte solution. For MRCG the colon was filled with ca. 2000 ml of tap water. Imaging was performed with a 1.5T MR scanner in the prone position. RESULTS: Most unpleasant for the patients was the preceding bowel preparation (70%), followed by colonoscopy (14%) and MRCG (8%). The preferred method was MRCG (58%) followed by colonoscopy (20,5%). The most unpleasant symptoms named by patients were the amount of oral electrolyte solution that had to be drunk (34%), abdominal pressure (25%), nausea (24%) because of bowel preparation, body positioning (25%) and rectal tube (13%) during MRCG, abdominal pressure (19%) and pain (18%) during colonoscopy. CONCLUSION: Patients' acceptance of MRCG indicates that it has a potential role as an additional diagnostic tool in secondary prevention of colorectal cancer.

Aged↗
PubMed2006

A phase I/II multicentric trial of gemcitabine and epirubicin in patients with advanced pancreatic carcinoma.

Potential synergistic interaction between gemcitabine (GEM) and epirubicin (EPI) in pancreatic cancer have been described previously. The maximum-tolerated dose in this trial was GEM 1000 mg m(-2) and EPI 45 mg m(-2). Median time to progression was 5.1 months and median survival time 7.4 months. This combination appears well tolerated and shows promising clinical activity.

Adult↗
PubMed2006

[The management of bleeding ulcers].

Bleeding peptic ulcers are responsible for about half of all upper gastrointestinal hemorrhages, one of the most frequent gastroenterological emergencies. In its pathogenesis, infection with Helicobacter pylori and the use of ulcerogenic drugs play a dominant role. Endoscopy has to be performed urgently when a decline in hemoglobin and/or hemodynamic instability occurs. The indications for local endoscopic therapy depend on the Forrest criteria, which include bleeding and the presence or absence of a blood clot or visible vessel. Local endoscopic therapy comprises injections and mechanical or thermal procedures. The efficacy of these procedures has been demonstrated. Additionally, proton pump inhibitors are administered. The prognosis for bleeding ulcers depends on the endoscopic findings as well as the age and comorbidity of the patients.

Endoscopy, Gastrointestinal↗
PubMed2006

[Space-occupying lesion of the pancreas--how frequently not due to a suspected ductal adenocarcinoma?].

In patients with a space-occupying lesion of the pancreas at first a primary ductal adenocarcinoma is considered as the cause. Other tumours or metastases are assumed to occur very rarely. Therapy and prognosis of other pancreas tumours differ from therapy and prognosis of a primary ductal adenocarcinoma. We therefore examined the question of how frequently a space-occupying lesion of the pancreas was not due to a ductal adenocarcinoma in our case materials. Retrospectively 70 patients who had undergone a percutaneous puncture of a space-occupying mass of the pancreas under ultrasonographic control were included in the study (34 women, 36 men). In 62 patients a clear histological diagnosis was possible on the basis of the biopsy. In 53 cases (76 %) a primary adenocarcinoma of the pancreas could be diagnosed. In 5 patients (7 %) these masses turned out to be metastases of a previously known malignant tumour disease (2 x mammary carcinoma, 2 x gastric carcinoma, 1 x sigmoid carcinoma). Other tumours could be detected in 4 cases (6 %) including a tuberculoma, an endocrine tumour, a fusocellular sarcoma with partial neurogenic differentiation and a large-cell and pleomorphic-cell anaplastic, partly sarcomatoid carcinoma. In patients with a space-occupying lesion of the pancreas, tumours other than a ductal adenocarcinoma are not rare. In particular, in cases of a previously known malignant tumour disease a space-occupying lesion of the pancreas can also turn out to be a metastasis. Every other individual tumour entity is rare. Other tumour entities at large, however, are found in daily routine. The preoperative biopsy of space-occupying lesions of the pancreas, therefore, still has a clinical importance for the further therapy planning.

Aged↗
PubMed2006

Long-Segment early squamous cell carcinoma of the proximal esophagus: curative treatment and long-term follow-up after 5-aminolevulinic acid (5-ALA)-photodynamic therapy.

Photodynamic therapy (PDT) is an established treatment for the ablation of dysplastic Barrett's epithelium and early esophageal carcinoma, but no data have been published on curative 5-aminolevulinic acid (5-ALA)-PDT for long-segment early esophageal cancer with infiltration of the upper sphincter. We describe successful curative treatment of an unusual early long-segment squamous cell carcinoma (uT1a,N0) of the proximal esophagus (18 - 28 cm aborally), with three sessions of 5-ALA-PDT. Endoscopic and endosonographic follow-up macroscopically showed a complete remission of the tumor, proven by biopsy showing total histological ablation. After a follow-up period of 23 months, there has been no indication of tumor recurrence. Early superficial (< 3 mm) squamous cell carcinomas of the esophagus can be ablated completely by 5-ALA-PDT. However, long-term follow-up is required in order to prove the effectiveness of endoscopic ablation therapy for early esophageal cancer.

Aminolevulinic Acid↗
PubMed2006

Frequency of small bowel polyps in patients with duodenal adenoma but without familial adenomatous polyposis.

INTRODUCTION: It is uncertain whether patients with duodenal adenomas without familial adenomatous polyposis (FAP) are at greater risk for small bowel neoplasia. We therefore conducted a study to determine the frequency of small bowel polyps in patients with non-papillary duodenal adenomas using capsule endoscopy for small bowel examination. PATIENTS AND METHODS: 14 patients (8 women, 6 men; mean age 67 +/- 10 years; range: 49 - 77 years) with non-papillary duodenal adenomas without FAP were included. All patients underwent wireless capsule endoscopy. The results were compared with an age- and sex-matched cohort of patients undergoing capsule endoscopy for suspected small bowel disease. RESULTS: Overall, 15 polyps ranging between 1 and 8 mm in diameter were detected in eight patients of the study group, whereas no polyps could be identified in the control group. Natural excretion of the capsule within 24 hours was always reported and no complications were reported by any of the patients. Other pathological findings were multiple angiodysplasias in two patients of the study group. In the control group capsule endoscopy detected angiodysplasias in 5 patients with the indication obscure gastrointestinal bleeding, and inflammatory lesions in 2 patients with suspected Crohn's disease. CONCLUSIONS: Based on the results of this prospective study, the frequency of small bowel polyps in patients with duodenal adenomas without familial adenomatous polyposis appears to be increased compared with a control group undergoing capsule endoscopy for other reasons. In none of the patients was the management altered. Follow-up data of these patients will be needed.

Adenoma↗
PubMed2006

Course of erosive gastroesophageal reflux disease (ERD)--a prospective examination under therapeutic daily life conditions with a mean follow-up of 6.5 years.

BACKGROUND: Endoscopic screening for Barrett's esophagus is an accepted base for surveillance strategies of Barrett's esophagus; data on the natural history of erosive gastroesophageal reflux disease (ERD) are sparse. Therefore, we performed a prospective long-term follow-up examination of the course of ERD to confirm the recommendation of a once-in-lifetime endoscopy as a screening programme for Barrett's esophagus. METHODS: Patients not older than 60 years with reflux symptoms and a first time diagnosis of ERD or Barrett's esophagus at the time of inclusion were identified. Patients were followed up by a further upper GI endoscopy after at least 5 years. They were interviewed about clinical symptoms and medication use. RESULTS: One hundred and thirty-five patients were included. Follow-up data were obtained for 115 patients. Seventy-one patients (22 female, 49 male, average age: 48.3 years; range: 22-60 years) remained in the programme, 37 patients died from unrelated diseases within the follow-up period (mostly due to cardiovascluar diseases). Seven patients were excluded because of missing videoendoscopy. The average follow-up period was 78.3 (range: 60-85) months. During this time, 76 % of the patients received medical therapy. Only three patients (4.5 %) showed progression of erosive lesions, whereas two patients developed a short-segment Barrett's esophagus without intraepithealial neoplasia. These 5 patients received no medical therapy. CONCLUSIONS: Progression of ERD is an unlikely event. Once-in-lifetime endoscopy is an adequate screening tool that may serve as a basis for a Barrett's esophagus surveillance program.

Adult↗
PubMed2006

In vitro evaluation of forces exerted by a new computer-assisted colonoscope (the NeoGuide Endoscopy System).

BACKGROUND: The NeoGuide Endoscopy System (NES) utilizes a fully articulated, computer-controlled insertion tube that allows proximal segments of the colonoscope to follow the path taken by the tip as it is manually advanced through the colon. The system was designed to eliminate looping and scope displacement during colonoscopy. MATERIAL AND METHODS: Using in vitro testing, an inanimate flexible model of the colon incorporating four force transducers located at the key flexure points was employed to measure the axial forces on the colon wall during colonoscopy. In the second part of the study, 10 gastroenterologists performed colonoscopies, using a training latex-based simulator, with the NES and with a standard colonoscope. Colonic displacement was independently assessed by six gastroenterologists, with each evaluating endoscopist assigning a score between 0 and 5 corresponding to the maximum colonic displacement observed at any location. RESULTS: The average measured forces (in lbs) at three of the four flexure points were significantly lower ( P < 0.05) when the NES was used. The mean colonic displacement was significantly lower for procedures performed with the NES compared with the standard colonoscope (2.36 vs. 4.26, P < 0.001). Interobserver agreement regarding the degree of colonic displacement due to looping was moderate (weighted kappa = 0.45, P < 0.01). CONCLUSIONS: Colonoscopy with the NES was associated with significantly less looping and lateral force required for advancement than procedures with a standard colonoscope. The reduced amount of looping suggests that use of the NES in patients might be associated with less discomfort and thus require less sedation.

Biomechanical Phenomena↗
PubMed2005

[Complications of diagnostic laparoscopy].

BACKGROUND AND OBJECTIVE: The frequency of diagnostic laparoscopy performed by internists has increased for several years once again -- especially performed as minilaparoscopy. A determination of the value of diagnostic laparoscopy is possible only with knowledge of the complication rate. PATIENTS AND METHODS: We reviewed a consecutive series of 675 laparoscopies (422male, 253 female, age 15 - 85 ) from 1996 to 2003 in our clinic. Possible risk factors for complications were analyzed. RESULTS: Minor complications occurred in 35/675 (5,2 %) laparoscopies, major complications in 8/675 (1,1 %) laparoscopies. There was no significant difference between conventional and minilaparoscopies. The existence of Child C cirrhosis was the only significiant risk factor identified for the occurrence of a major complication. CONCLUSION: Both conventional and minilaparoscopy have an acceptable rate of complications. When Child C cirrhosis is present, laparoscopy should be restricted to very few patients, as the complication rate is elevated in this condition.

Adolescent↗