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Biomedical subjects

K Ewe

Publications and source records attributed to K Ewe.

At least 73 records · Page 4Linked to original sources
PubMed1986

Investigation of the sphincter of Oddi before, immediately after and six weeks after endoscopic papillotomy.

The sphincter of Oddi was investigated before, immediately after and 6 weeks after endoscopic sphincterotomy by endoscopic inspection, ERCP manometry, and by X-ray following retrograde cholangiography in 14 patients presenting with bile duct stones. The sphincter motility was normal before sphincterotomy. Following electrocautery no sphincter motility was noted, the sphincter baseline pressure showed considerable interindividual changes, and the length of the residual sphincter seemed to be only slightly reduced from 14.1 mm (before) to 10.9 mm. Despite this fact, bile duct concrements of more than 10 mm in diameter could be extracted without difficulty in all patients, confirming the adequacy of the sphincterotomy. Six weeks after sphincterotomy the sphincter length was 1.9 mm (0 to 7 mm) and in 6 patients the sphincter was completely incompetent, as demonstrated by the bile duct pressure (0 mmHg) and aerocholia, in the remaining 8 patients a small residual sphincter was able to maintain sphincter patency. We conclude that ERCP manometry cannot serve to confirm completeness of sphincterotomy immediately after electrocautery. But it would be possible to perform "semisphincterotomy" by assessing the sphincter length before cutting. Since sphincterotomy causes sphincter incompetence only in some patients, ERCP manometry would be a reliable aid for classifying the patients for follow-up studies.

Aged↗
PubMed1986

Postprandial cholylglycine serum concentration and extent of ileal inflammation or resection in Crohn's disease.

Postprandial cholylglycine serum concentration was determined in 45 resected and non-resected patients with Crohn's disease of the distal ileum. Cholylglycine serum concentration after meal stimulus in patients with ileal involvement of more than 30 cm was significantly lower than in controls and in patients with minor spread of inflammation. In patients with inflammation area less than 30 cm, there was a somewhat faster and higher increase and delayed decline of postprandial cholylglycine serum concentration. The present study shows that postprandial cholylglycine serum level gives a good estimate of the extent of ileal inflammation or resection.

Crohn Disease↗
PubMed1986

Factitious diarrhoea.

Gastroenterologists often have to deal with patients with chronic diarrhoea. The vast majority will suffer from functional bowel syndrome. A few will present with a clear-cut organic disease. If chronic diarrhoea remains unexplained after extensive testing, if daily stool volume is high (greater than 500 g/24 h) and if the patient is female, factitious diarrhoea should be considered. Melanosis coli on sigmoidoscopy, cathartic colon on barium enema examination, a positive room search and chemical detection of the presence of specific laxatives in urine or stool may lead to the correct diagnosis. Treatment and management of such patients is difficult. Denial is the usual response to confrontation. Counselling and guidance by psychiatrists or psychologists is often not accepted by the patient. In many cases the role of the physician may be limited to preventing further potentially dangerous diagnostic and therapeutic interventions.

Adult↗
PubMed1985

Antiinflammatory treatment and intestinal alpha 1-antitrypsin clearance in active Crohn's disease.

Intestinal alpha 1-antitrypsin clearance was quantified in 17 patients with clinically active Crohn's disease before and after a six-week period of treatment with sulfasalazine and methylprednisolone. Before the study, alpha 1-antitrypsin clearance and, hence, enteric protein loss was elevated as being above control values in 16 patients. After therapy, clearance values decreased in 11 and were normalized in five patients. Serum albumin level was normalized in 11 of 12 patients who had hypoalbuminemia before the study. Clinical condition was improved in all but 1 patient after treatment. There was no close correlation between alpha 1-antitrypsin clearance and disease activity index. These results indicate that antiinflammatory therapy has a beneficial effect on enteric protein loss in Crohn's disease. The measurement of alpha 1-antitrypsin clearance provides a useful adjunctive technique in evaluating intestinal inflammatory activity, and it seems to be of use in following the efficacy of treatment in the course of illness in Crohn's disease.

Adolescent↗
PubMed1985

ERCP using a special catheter with external steering. A reliable aid in typical ERCP problems.

ERCP is the most sensitive procedure for opacification of the bile and pancreatic ducts. The procedure fails, however, in up to 60% of Billroth II resected patients, and in 5% of nongastrectomized patients, often owing to problems of papillary cannulation with the conventional ERC-catheter, or insufficient control in the bile duct. Therefore, we attempted to perform ERCP with a catheter provided with external steering, which can be introduced through the channel of any commercially available endoscope. This catheter permitted successful ERCP in 11 patients in whom conventional ERCP technique had failed. The endoscopic procedure with the catheter described was simple and reduced papillary cannulation problems in patients with juxtapapillary diverticulum and in those with Billroth II resection, and it permitted selective opacification of intrahepatic bile ducts or the cystic duct.

Catheterization↗
PubMed1985

Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure.

It is widely accepted that glyceryl trinitrate (GTN) effectively dilates the smooth muscles of blood vessels. A similar effect has been postulated on the smooth muscles in the gastrointestinal tract. In this study the motility of the sphincter of Oddi and the common bile duct pressure as determined by endoscopic manometry was investigated in nine patients before and after sublingual application of 1.2 mg GTN (nitro group). Eight untreated patients served as controls. Three minutes after application of GTN the papillary contraction amplitude decreased from 69.3 +/- 4.3 mmHg to 36.8 +/- 5.1 mmHg (p less than 0.005) and the papillary baseline pressure fell from 8.9 +/- 0.6 mmHg to 2.9 +/- 0.2 mmHg (p less than 0.005) respectively. The contraction frequency in the nitro group and all motility parameters in the control group remained unchanged. These results indicate that GTN does not influence the sphincter of Oddi motility, but it relaxes very effectively the sphincter of Oddi muscle. Thus, GTN should be taken into account for the treatment of biliary colic. In our endoscopic unit GTN proved to be useful as premedication for endoscopic examinations, particularly for the removal of small and medium size common bile duct stones through the intact papilla.

Adolescent↗
PubMed1985

Effect of the artificially elevated common bile duct pressure on the motor activity and function of the papilla of Vater. A study by endoscopic manometry.

In 10 patients without disease of the pancreatico-biliary system, the common bile duct pressure was artificially elevated by endoscopic retrograde feeding with saline under manometric control. The motor activity of the papilla of Vater was recorded by endoscopic manometry using the hydraulic capillary perfusion system according to Arndorfer. Compared to the baseline motility, a mild pressure elevation (from 9.75 +/- 1.8 to 13.5 +/- 0.26 mm Hg) had no effect. After the following strong pressure elevation (to 32 +/- 0.9 mm Hg), however, the papillary residual pressure and the wave duration of the papillary contractions increased significantly (p less than 0.001) from 5.5 +/- 0.5 s and 6.3 +/- 0.16 mm Hg to 10.7 +/- 0.75 s and 8.6 +/- 0.64 mm Hg, whereas the papillary contraction frequency and amplitude were not affected. These data indicate several clinically important speculations.

Adult↗