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J F Riemann

Publications and source records attributed to J F Riemann.

At least 19 recordsLinked to original sources
PubMed1995

[Erythrohepatic protoporphyria. A rare differential diagnosis of parenchymatous jaundice].

Parenchymatous jaundice persisted in a 59-year-old woman[correction of man] after cholecystectomy for gallbladder stones. She had a history of skin sensitivity to light. Laboratory tests demonstrated an excessive increase of free protoporphyrin in red blood cells and plasma, as well as abnormal coproporphyrinuria, indicating the diagnosis of far advanced erythropoietic protoporphyria with an hepatobiliary component. Conservative treatment with ursodeoxycholic acid brought no relief and liver transplantation was therefore performed. Bilirubin concentration and all other liver parameters became normal within 2 months postoperatively. No complications have occurred in a follow-up period of one year. The combination of light-sensitive skin with gall-stones and, at a later stage, parenchymatous jaundice should always make one consider protoporphyria. As recognition of the initial liver phase in erythropoietic protoporphyria is decisive for the success of treatment, regular examination of liver parameters and of the porphyrins in blood, urine and stool is recommended.

Coproporphyrins↗
PubMed1995

[Multicenter prospective study of the current status of treatment for bleeding ulcer in Germany].

The current state of ulcer treatment in Germany was analysed in a prospective multi-centre study. It was based on 1139 consecutive patients admitted to the participating hospitals because of upper gastrointestinal bleeding. The source of the bleeding was identified by diagnostic endoscopy in 1075 patients (94%), from a gastric and/or duodenal ulcer in 546 of them (mean age 62 +/- 18 years). Using Forrest's classification, 4% of patients were in bleeding stage Ia, 17% in stage Ib, 16% stage IIa, 30% stage IIb and 33% stage III. An attempt to arrest bleeding through the endoscope was made in 233 patients (43%): more often with tissue-preserving substances (epinephrine +/- NaCl in 36%, fibrin glue +/- epinephrine in 24%) than with tissue-damaging procedures (epinephrine + polidocanol +/- NaCl in 26%, epinephrine + thermocoagulation in 7%). Primary haemostasis was achieved in 219 patients (94%). There was a total of 66 recurrences of bleeding (12%), but the rate was 18% after endoscopic haemostasis. 64 patients (12%) required operative intervention, including initial emergency operations. Severe complications (infections, organic failure) occurred in 82 patients (16%). 114 of the 546 patients were in the high risk group (older than 60 years; high amount of bleeding). Their bleeding recurrence and mortality rates (27 and 22%, respectively) were significantly higher (P < 0.01) than those of the total group. Overall mortality rate was 11% (58 patients). The mortality rate depended on the severity of initial bleeding (26% for Forrest group Ia). After recurrent bleeding the mortality rate was 34% with conservative and 33% with operative treatment. 7% of all deaths were the direct result of bleeding. The following factors prognostically closely correlated with mortality rate: age of patient (P < 0.01); haemoglobin < 8 g/dl on admission (P < 0.05); initial severity of bleeding (Forrest group I; P < 0.05); and recurrence of bleeding (P < 0.001).

Age Factors↗
PubMed1995

Clinical comparison of extracorporeal piezoelectric lithotripsy (EPL) and intracorporeal electrohydraulic lithotripsy (EHL) in difficult bile duct stones. A prospective randomized trial.

Today, nearly 90% of common bile duct stones are extracted endoscopically. Problems are encountered if there are large stones or a duct stenosis. Extracorporeal piezoelectric lithotripsy (EPL) as well as intracorporeal electrohydraulic lithotripsy (EHL) serve as an alternative to surgical intervention for those few patients in whom endoscopic measures have failed. A total of 35 patients with common bile duct stones in whom conventional endoscopic treatment had failed were selected on the condition that stone visualization through ultrasound was possible and that the papilla was within easy reach of the endoscope. Patients fulfilling the inclusion criteria were randomly treated either by EPL or EHL. The average age of our patients was 73 years. The main reasons for failure of conventional endoscopy were due to the large size of the stones (13 patients), impacted stones (16), or the presence of a biliary stricture (6). In the EPL group, visualization of the stones by ultrasound and ensuing treatment were possible in 16 of 18 patients (89%); stones could be fragmented in 15 patients. In 13 patients, the biliary tree could then be completely freed of calculi; the success rate was 72% for all the patients (13 of 18). On average, the patients had 2.3 treatments on the lithotripter, and 3870 shock waves were applied per treatment. In the EHL group stones were successfully fragmented in 13 of 17 patients (76.5%). The average number of treatments was 1.4. Comparing both therapies, there was no difference in stone-free rates. In both groups, additional endoscopic interventions were necessary to clear the bile duct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Treatment of advanced pancreatic cancer with 5-fluorouracil, folinic acid and interferon alpha-2A: results of a phase II trial.

Interferon alpha-2a (IFN-alpha) and folinic acid (FA) have been shown to modulate the cytotoxic effects of 5-fluorouracil (5-FU) in the treatment of cancer. A phase II study was initiated to evaluate the effect of a combination of 5-FU/FA/IFN-alpha in patients with advanced pancreatic cancer. Sixty previously untreated patients with advanced adenocarcinoma of the pancreas were treated with 500 mg m-2 FU via an intravenous bolus 1 h after the initiation of a 2 h infusion of 500 mg m-2 FA. Before starting the FA infusion, 6 million units (MU) of IFN-alpha was administered subcutaneously. The treatment was repeated once a week. Of 57 evaluable patients, eight (14%) had a partial response (PR), eight (14%) a minor response (MR) and 28 (49%) no change of disease (NC). Thirteen patients (23%) had progressive disease (PD). The median survival time was 10 months for all patients, 22 months for patients with partial remission and 5 months for patients with progressive disease. Many patients with tumour-related pain whose tumours were affected in terms of PR, MR, NC were free of pain during treatment with this regimen (22/36 patients). The common toxicities observed were fever (56%), nausea (37%) and diarrhoea (33%). These data suggest that biochemical modulation of 5-FU with FA and IFN-alpha has some positive effects in the treatment of pancreatic cancer of moderate toxicity.

Adenocarcinoma↗
PubMed1995

[Ultrasound-guided extracorporeal piezoelectric lithotripsy of bile duct calculi].

AIM: Extracorporeal shock-wave lithotripsy (ESWL) with underwater spark discharge and stone localisation via x-ray has become established in the treatment of difficult bile duct stones. First results with the piezoelectric lithotripter (EPL) in our department have also been promising. METHOD: Between 1989 and 1993 we were able to treat 79 patients (mean age 76 years) with problematic bile duct stones with the EPL. Twenty-seven patients had solitary stones, 52 patients presented with multiple stones. Seventy-one patients received a nasobiliary tube to decompress the biliary system. For extracorporeal lithotripsy, we used a piezoelectric lithotripter (Piezolith 2300, R. Wolf, Knittlingen, Germany). RESULTS: Visualisation of the stones by ultrasound and ensuing treatment were possible in 71 out of 79 patients (90%), and complete stone removal was achieved in 62 patients (78.5%) after 7,595 shock-waves were applied per patient on average. In 55 patients, endoscopic extraction of fragments was performed to avoid fragment complications. Nearly all patients in whom extracorporeal lithotripsy failed were cleared of their stones by additional use of intracorporeal electrohydraulic lithotripsy. Three patients received palliatively an endoprosthesis and two patients were referred to surgery. CONCLUSION: EPL with sonographic stone localisation and mild sedo-analgesia is a valuable adjunct in the treatment of difficult biliary tract calculi. It is a worthwhile alternative especially for elderly patients who would be at high risk on general anaesthesia.

Aged↗
PubMed1995

Helicobacter pylori-associated gastritis: does it play a role in functional dyspepsia?

OBJECTIVES: The goal of this study is to averiguate whether Helicobacter pylori (Hp)-associated gastritis is involved in the etiology of functional dyspepsia (FD) or, at least in a subset of these patients. METHODS: 103 consecutive FD patients were prospectively analyzed and subdivided according to their main complaints into ulcer-like FD (n = 31), dysmotility-like FD (n = 24) or nonspecific FD (n = 48). After endoscopy with gastric biopsy, gastritis and Hp infection were assessed and graded by histology according to the Sydney System. The prevalence of gastritis, Hp and disease activity were analyzed among the three FD subtypes and against 42 age, sex and race matched controls. RESULTS: Hp was identified in 64 (62%) of the FD group and in 23 (55%) of the controls (p > 0.20, NS). We neither observed any increased prevalence of the infection among FD subgroups (dysmotility-like 58%, ulcer-like 58%, unspecified 67%), nor in the activity of gastritis among FD subgroups and controls. We conclude that Helicobacter pylori gastritis per se is not associated with functional dyspepsia.

Adult↗
PubMed1995

[Percutaneous transhepatic cholangioscopy (PTCS)--an important supplement in diagnosis and therapy of biliary tract diseases (indications, technique and results)].

In 39 patients with biliary disease inappropriate for a transpapillary access (21 m, 18 f, mean age 62 y.) 61 percutaneous transhepatic cholangioscopies (PTCS) were performed. In 28 cases (71.8%) diagnostic PTCS was done in order to investigate the etiology of a biliary stenosis. Nine of these patients had histological as well as clinical outcome indicating a benign lesion. Histology was positive for malignancy in 14 (82%) out of 17 patients with clinically assumed malignant stenosis. The etiology of the stenosis remained obscure from a clinical point of view in two cases with negative histology for malignancy. In twelve patients (30.7%) we performed PTCS for endoscopically controlled laser or electrohydraulic lithotripsy of bile duct stones. The procedure was successful in all patients and stone fragments were delivered to the duodenum by saline lavage. Seven of these patients had stones combined with a benign stenosis and were additionally treated by long-term drainage (Yamakawa drain) for three to twelve months. Two of the seven patients had no relaps of the biliary stricture after a follow-up of ten and twelve months respectively. In five cases (12.8%) PTCS controlled insertion of a guide-wire was attempted after failure of the radiologically guided internalization of the percutaneous drainage. The procedure was successful in three of these patients.

Adult↗
PubMed1995

[The secondary prevention of colorectal carcinoma by polyp removal].

PURPOSE: Colorectal adenomas are established precursor lesions of colorectal carcinoma. Molecular biologic investigations suggest a developing cycle from normal mucosa and adenoma to carcinoma via influence of oncogens and tumor suppressor genes. Polypectomy is supposed to reduce the colorectal cancer risk. PATIENTS AND METHODS: Studies published in this field until now were analysed and it was discussed whether consequent endoscopic polypectomy of colorectal adenomas adds to secondary prevention of colorectal carcinoma. RESULTS: A variety of studies has shown that removing the precursors of colorectal carcinoma leads to a distinct reduction of colorectal carcinoma. A large American prospective study has confirmed these observations and has shown that compared to the expected incidence, found in large population studies, the risk of colorectal carcinoma can be reduced by up to 90%. As a consequence, besides complete polypectomy the regular follow-up is mandatory to detect and treat recurrent polyps. CONCLUSION: Consequent endoscopic polypectomy of all colon adenomas which today usually is performed with a diathermy loop is a secondary prevention of colorectal carcinoma. The surveillance should be performed along the lines of the German Cancer Society.

Carcinoma↗
PubMed1995

[Anastomotic recurrence with tumor stenosis after Billroth II gastrectomy for adenocarcinoma: implantation of 2 metal stents as palliative therapy].

We report on a 70 year old patient with a great relapse in the region of the anastomosis after a palliative, subtotal gastrectomy with Billroth-II-gastrojejunostomie because of an adenocarcinoma one year before. He was unable to swallow fluids or solid food. The possibility of a sufficient gastroenteroanastomosis was certainly limited (great tumor-mass left during operation). So we implantated two metal stents in the afferent and the efferent limb, respectively. The patient's vomiting completely relieved and he was able to swallow fluid food again. After that treatment the patient's quality of live noticeably increased. Furthermore, by stenting the afferent limb a sufficient drainage out of the duodenum could be reached, thereby preventing an increasing cholestasis.

Adenocarcinoma, Mucinous↗
PubMed1995

Symptoms of post-extracorporeal shock wave lithotripsy: long-term analysis of gallstone patients before and after successful shock wave lithotripsy.

OBJECTIVE: Considerable information is presently available about stone-free rates after extracorporeal shock wave lithotripsy (ESWL) of gallbladder stones. Another important item and one that has been poorly investigated is symptom relief after successful ESWL. The aim of the present trial was to determine the course of biliary and gastrointestinal symptoms after successful ESWL of gallstones. METHODS: Ninety patients were followed for an average of 18 months after stone disappearance and discontinuation of oral bile acids. A standardized questionnaire was combined with a clinical and ultrasound examination. Relief of symptoms was correlated to patient characteristics, stone volume, and gallbladder functions. RESULTS: Twelve patients (13%) developed recurrent stones. The probability of stone recurrence was 5.5% (+/- 2.5%) after 1 yr, 12% (+/- 4.5%) after 2 yr, and 30.5% (+/- 9.5%) after 3 yr. Sixty-two of 78 stone-free patients were asymptomatic (80%). Most patients lost their typical biliary symptoms, but statistics also revealed significant differences of nonspecific symptoms and food intolerances pre- and postlithotripsy. CONCLUSIONS: This trial has confirmed that patients with symptomatic gallstone disease exhibit a wide spectrum of symptoms, many of which are relieved by ESWL. The fact that at least every fifth patient is not free of symptoms after the gallstone has been removed is in keeping with the findings after cholecystectomy. According to our data, recurrence rate after successful ESWL is higher than previously reported and similar to results after oral litholysis, with no differences between single and multiple stones.

Adult↗
PubMed1995

[Bleeding peptic ulcers--concept for acute therapy].

Acute ulcer bleeding still is a life-threatening event. The therapeutic goal is to establish intensity, activity and location of the bleeding and to assess primary hemostasis by consequent endoscopic therapy, also preventing recurrence significantly. With the injection method, primary hemostasis accounts for over 90% success. Also recurrent bleeding can be stopped to the same extent. Endoscopic doppler allows a qualitative and quantitative registration of potentially dangerous vessels on the ulcer base. Drug therapy does serve for the acute treatment to a lesser extent; it is more valid for the initiation of the conservative ulcer therapy. Surgical interventions therefore confined to risk patients in whom a primary hemostasis failed or the ulcer is located in a dangerous site, for instance in the back wall of the duodenal bulb.

Acute Disease↗
PubMed1994

[Acute pancreatitis due to the rupture of an echinococcal cyst into the bile duct system].

A 47-year-old woman with stones in the gall-bladder suddenly developed severe upper abdominal pain. Cholesterol concentration was elevated, as were amylase (555 U/l) and lipase (408 U/l) concentrations, suggesting biliary pancreatitis. Endoscopic retrograde cholangiography demonstrated a cyst, about 10 cm in diameter, in the left lobe of the liver, connected to the biliary tract system. Ultrasonography and computed tomography additionally showed a smaller cyst in the right lobe. Infection with Echinococcus granulosus was proven microbiologically on bile (demonstration of hooklets and protoscolices) as well as serologically. Transpapillary cholangioscopy demonstrated daughter cysts within the echinococcal cyst. The main cyst was rinsed with 20% NaCl for 10 days via a nasocystic catheter. In addition, mebendazole (three times daily 1000 mg) was administered for 13 months. The signs if inflammation receded and the cyst shrank to a small residual volume. Surgical intervention became unnecessary.

Acute Disease↗