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J Ochmann

Publications and source records attributed to J Ochmann.

32 records · Page 2Linked to original sources
PubMed1994

[Hemopurification methods in the surgical unit].

The authors submit their initial experience with the activities of the hemodialyzation centre at a surgical department. They present an analysis of 79 patients where some hemopurifying procedures or their combinations were applied. These methods make it possible to perform more safely extensive surgery, they improve the care of patients with multiple injuries and extend therapeutic possibilities in acute pancreatitis and hyperbilirubinaemia when they cannot be treated by other methods. From the range of hemopurifying methods they consider the following most suitable for a surgical department: classical acute haemodialysis, hemodiafiltration, haemoperfusion and continuous arteriovenous dialysis.

Acute Kidney Injury↗
PubMed1994

[Is it possible to predict a decrease in portal pressure after administration of ACE inhibitors?].

We have previously shown that angiotensin converting enzyme inhibitor enalapril causes a potent decrease in portal pressure gradient, but only in about one half of patients with portal hypertension and an episode of bleeding esophageal varices in patient's history. Twenty-one consecutive patients after first episode of bleeding from esophageal varices were enrolled in the trial. Patients were treated by sclerotherapy in combination with enalapril. The level of ACE in patients with portal hypertension (10.4, SD 4.5) was significantly higher than in normal population (4.5, SD 1.3 mu kat/l-1) [p < 0.001]. After 3 months treatment decreased ACE to normal or subnormal levels in all 21 patients (2.9, SD 1.5 mu kat.l-1) [p < 0.001], but simultaneously measured hepatic venous pressure gradient decreased more than 3 mm Hg only in 11 (52%). No correlation between changes of portal pressure gradient and changes of ACE concentrations were found. We conclude that patients with portal hypertension have significantly higher serum ACE level with a large decrease after enalapril, but it is not possible to predict the effect of enalapril on portal pressure by estimation of ACE level in serum in individual patient.

Adolescent↗
PubMed1993

[Another source of hemorrhage--risks for patients with esophageal varices].

The authors treated during the past three years 312 patients with oesophageal varices after the first haemorrhage. All patients were treated by endoscopic sclerotization of oesophageal varices and drugs which reduce the excessive portal pressure. After a minimum of two sclerotherapeutic sessions, following control of acute haemorrhage, the authors observed a relapse of haemorrhage from the upper gastrointestinal tract in 38 patients. In 20 of them the relapse of haemorrhage was again from oesophageal varices, but in 18 patients it was of different origin and would not be affected by classical treatment with a Sengstaken tube. The authors draw attention to the necessity of emergency endoscopy in these patients and to the fact that possible postponement of rational treatment, e.g. in duodenal ulcers insertion of a tube, may threaten the patient's life.

Adolescent↗
PubMed1992

[How should treatment of esophageal varices proceed?].

The authors submit their experience and data from the literature on the problem of oesophageal varices. In haemorrhage of varices at present the most successful procedure is endoscopic haemostasis concurrently with intensive treatment focused on the basic disease and replacement of blood losses. In patients with a history of haemorrhage from varices endoscopic sclerotization is generally recommended. The authors supplement it with the promising medicamentous reduction of the portal pressure. Other procedures, i.e. surgery, are indicated only in a minority of patients whose varices do not reposed to haemostasis and medicamentous reduction of high portal pressure. The problem how to proceed in varices which did not bleed so far is still unresolved. The authors recommend individual evaluation and submit their own procedure.

Esophageal and Gastric Varices↗
PubMed1992

[Endoscopic "perestrojka"].

The authors discuss in a brief review the mighty development of invasive endoscopy in the next few years. Based on their own findings as well as data in the literature, they assume that it will be necessary to prepare theoretical as well as practical material for this quite newly developing discipline. It penetrates already at present to all European surgical and gastroenterological departments and changes fundamentally the approach to diagnosis and treatment of diseases of the gastrointestinal tract.

Endoscopy↗
PubMed1992

[The ACE inhibitor, enalapril, in portal hypertension. A prospective placebo controlled study].

The haemodynamic action of long-term (3 months) therapy with enalapril, a potent inhibitor of angiotensin convertase was investigated in 12 patients selected at random, all suffering from portal hypertension and a previous episode of haemorrhage from oesophageal varices. In all these patients after one-week intervals sclerotization of oesophageal varices was made. As controls served a group of 13 patients treated only by sclerotherapy and placebo. In the enalapril treated group after three months the pressure in the wedged hepatic vein (25 +/- 4.8 vs. 21.3 4.8 mm Hg) and the pressure gradient wedged free hepatic vein (17.0 +/- 6.0 vs. 12.6 +/- 3.4 mm Hg) were significantly lower than the initial values (p less than less than 0.01) in the enalapril treated group. A very marked decline (greater than 3 mm Hg) of this pressure was recorded in 50% of the patients. In the group treated by sclerotherapy and placebo the pressure gradient did not decline. During treatment no changes in the systemic haemodynamics and liver tests occurred. None of the patients died during the investigation and the subsequent 6-month period. The authors provided evidence that enalapril reduces the portal pressure in patients with hypertension, although not in all, and can be successfully used for the treatment of patients with oesophageal varices in combination with sclerotherapy.

Adult↗
PubMed1992

Effect of enalapril treatment and sclerotherapy of esophageal varices on hepatic hemodynamics in portal hypertension.

The hemodynamic effects of long-term (3 months) treatment with enalapril, a potent angiotensin converting enzyme inhibitor, were studied in 12 randomly selected patients with portal hypertension and a previous episode of hemorrhage from esophageal varices. All these patients underwent injection sclerotherapy of varices at 1-week intervals. As a control group 13 patients treated only with injection sclerotherapy and placebo were used. After 3 months the wedged hepatic venous pressure (25.5 +/- 4.8 vs. 21.3 +/- 4.8 mmHg) and the non-wedged hepatic venous pressure gradient (17.0 +/- 6.0 vs. 12.6 +/- 3.4 mmHg) were significantly lower than the basal values (p < 0.01) in the group treated with enalapril. A large decrease (> 3 mmHg) in these pressures was observed only in 50% of the patients. In the group treated with sclerotherapy+placebo this pressure reduction was not observed. Systemic hemodynamics and liver function tests did not change during the treatment. None of our patients died during the study or the next 6 months. We conclude that enalapril lowers portal pressure in patients with portal hypertension, although not in all of them, and may be used to good effect to manage patients with esophageal varices in combination with sclerotherapy.

Adult↗
PubMed1992

[Experience with 1000 sclerotizations of esophageal varices].

The authors submit the results of 1061 endoscopic sclerotizations of oesophageal varices in 183 patients. For sclerotization they used endoscopes of Olympus Co. at two-week intervals. Treatment was supplemented by administration of drugs reducing portal pressure. The number of complications associated with this treatment is very low. Serious life-threatening complications occur in much less than 1%. The authors consider endoscopic sclerotization of oesophageal varices after the first haemorrhage as the method of choice, in particular in combination with medicamentous treatment for reduction of portal pressure. They emphasize the necessity to perform these procedures in a department with adequate experience with sclerotizations where at least 100-200 sclerotization per year are performed. In the discussion other therapeutic possibilities are suggested. The problem of preventive sclerotization of varices has not been resolved so far. The authors recommend it in their department and use it in patients who according to the endoscopic finding or the level of the portocaval gradient are at risk of haemorrhage.

Adolescent↗
PubMed1991

[Emergency endoscopy in the diagnosis and treatment of hemorrhage in the upper part of the gastrointestinal system].

The authors describe, based on an analysis of 2970 patients subjected to endoscopy, the advantages of urgent endoscopy performed within six hours after admission to the surgical department. They refute former statements that urgent endoscopy is endoscopy performed within 24 or 48 hours. They discuss the different approach of endoscopists to different types of haemorrhage and to the time factor and emphasize the prognostic considerations of the endoscopist.

Emergencies↗
PubMed1990

[Recurrent peptic ulcer--surgical complications].

Recurrent ulcer is serious complication of surgical treatment. Resection, reconstructive operations under conditions of severe adhesions, inflammatory infiltrates and abscesses are exacting and often connected with complication. In the period of 1978-1987 the authors carried out 64 reoperations for recurrent peptic ulcer, incl. 39 cases, whom they had to operate urgently. 19 patients were reoperated on account of penetration and peroperation of the ulcer, 11 because of massive haemorrhage, and 9 patients because of gastrocolic fistulae. In reoperations, subtotal resection of the stomach with vagotomy was carried out in 66%. In 4 patients reoperated repeatedly, Zollinger-Ellison's syndrome was found and resection of the pancreas was performed simultaneously. The mortality rate in the group, including patients reoperated urgently, was 21.9% (i.e. 14). The authors emphasize that the main aim of reoperation must be long-term therapeutic results without recurrences of ulcers and without serious functional disturbances.

Adult↗
PubMedDate not supplied

The role of relaparoscopy in the management of bile leaks after laparoscopic cholecystectomy.

The incidence of bile leaks has increased with the advent of laparoscopic cholecystectomy. The present paper is focused on bile leaks--their diagnosis and management approaches with special consideration to relaparoscopy. From February 1992 to May 1995 a total of 1223 laparoscopic cholecystectomies were performed in two hospitals. Eight biliary leaks were found in the series under study (i.e. 0.65%). The diagnosis was confirmed by means of ultrasound, CT scans and ERCP. Three leaks resolved spontaneously on external drains placed during the operation. Two and three patients underwent laparotomy and relaparoscopy, respectively. The etiology of the leakage included three cases of ducts of Luschka, one cystic duct leak, and one retained CBD stone. the source of the remaining leaks was not determined. In all cases the management approaches comprised relaparoscopy and laparotomy. It may be concluded that an early diagnosis and management of bile leaks after laparoscopic cholecystectomies would prevent further complications.

Bile↗
PubMedDate not supplied

Recent position of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension.

Transjugular intrahepatic portosystemic shunt (TIPS) is a side-to-side portocaval shunt for threatening complications of portal hypertension. TIPS effectively decreases portal hypertension connecting the hepatic and portal vein with an expandable metal stent without the mortality and morbidity of an open surgical procedure. Technical success can be achieved in over 90% of patients, with procedure related mortality of 1-2%. The main problem is stenosis or occlusion of the shunt by neo-intimal hyperplasia narrowing the lumen of the shunt in 20-80% of patients during 6-12 months, but fortunately, most stenotic stents can be revised successfully. Recent indications for TIPS are acute variceal hemorrhage refractory to endoscopic treatment and recurrent variceal bleeding despite sclerotherapy or band ligation. TIPS insertion in the treatment of refractory ascites seems to be promising.

Humans↗
PubMedDate not supplied

Pantoprazole-based dual and triple therapy for the eradication of Helicobacter pylori infection: a randomized controlled trial.

BACKGROUND/AIMS: The eradication of Helicobacter pylori (Hp) infection in duodenal ulcer and dyspepsia has been achieved using various therapy regimens. The efficacy of protein pump inhibitor pantoprazole as part of these regimens has not been widely studied. METHODOLOGY: During a prospective randomized trial, 250 Hp positive patients with either duodenal ulcer, erosive bulbitis, or gastritis and dyspepsia were treated using 14 days of therapy 1) pantoprazole 40 mg daily and clarithromycin 500 mg b.i.d. (PC), 2) pantoprazole 40 mg daily and clarithromycin 500 mg b.i.d. plus amoxicillin 1 g b.i.d. (PCA), or 3) bismuth subcitrate 120 mg t.i.d., roxithromycin 150 mg b.i.d., metronidazole 250 mg b.i.d. plus ranitidin 300 mg (BRMR). Hp status was assessed on 3 tests at the inclusion (2-specimen rapid urease test, 2-specimen histology, serology) and 2 tests (2-specimen rapid urease test, 2-specimen histology) 4 weeks after the end of the treatment. RESULTS: The entry criteria was fulfilled in 250 patients, of whom 13 missed the control endoscopy. The treatment had to be discontinued for adverse effects in 8 (10%) BRMR patients, and 1 (1%) PCA patients. Compliance was 100% in the PC group. All ulcers were healed at the end of the study with one exception in the BRMR group. The best eradication rate of Hp was shown by the PCA group with 94.8% (n = 73/77) followed by the PC group with 82.5% (n = 66/80) and finally the BRMR with 67.6% (n = 48/71)-PCA:BRMR - p < 0.001; PC:BRMR-p < 0.001; PCA:PC-p < 0.05. CONCLUSION: This study showed that triple therapy using PPI pantoprazole combined with antibiotics clarithromycin and amoxicillin was very effective in the eradication of Hp and treatment of duodenal ulcer with rare side effects. The dual pantoprazole and clarithromycin therapy had the highest rate of patient compliance, but is less effective than triple therapy. The combination of ranitidin with bismuth based triple therapy had the highest number of adverse events and the lowest rate of Hp eradication and therefore, should not be recommended.

2-Pyridinylmethylsulfinylbenzimidazoles↗