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Biomedical subjects

L Demling

Publications and source records attributed to L Demling.

At least 91 records · Page 5Linked to original sources
PubMed1983

Mechanical lithotripsy through the intact papilla of vater.

The indications for endoscopic papillotomy are clearly defined. When only the normal risk presents, our working group favours an age limit of 50 years, below which the papilla should, as far as possible, be preserved. In the present case report, a possibility is described for effecting an endoscopic extraction of bile duct concrements through a completely intact papilla. It is thus apparent that, in certain cases, mechanical lithotripsy can also be employed to smash ductal stones through the intact papilla.

Adult↗
PubMed1983

Measurement of gut hormonal peptides in biopsies from human stomach and proximal small intestine.

Using sensitive and specific radioimmunoassays, concentrations of hormonal peptides have been measured in small biopsies taken from the human stomach, duodenum, and proximal jejunum. Comparison is made of these hormone concentrations and the number of respective endocrine cells present determined by quantitative immunocytochemistry. Immunoreactive somatostatin, VIP, motilin, and gastrin were detected in all regions examined, whereas secretin and GIP were undetectable in antral extracts. Enteroglucagon-like immunoreactivity was present only at and beyond the ligament of Treitz, although a few enteroglucagon-producing cells were shown by immunocytochemistry in the duodenum. The variation of hormone concentration was found to be small in these biopsies of normal tissue within each region of the gut examined, indicating that representative hormone concentrations may be reliably obtained from small biopsy tissues. An attempt has been made to establish reference values for gut hormone concentrations in such biopsies; this may allow future study of any changes in concentration that may occur in pathological conditions.

Adult↗
PubMed1983

[Therapeutic endoscopy].

The most important promotor for the development of techniques for therapeutic endoscopy was diagnostic polypectomy. This review gives a survey of modern techniques applied in therapeutic endoscopy: 1) Polypectomy: on the basis of the author's experience all colorectal polyps should be removed by endoscopy. This recommendation is based on the findings that 80% of these polyps are of neoplastic origin. In the upper gastrointestinal tract endoscopic polypectomy is not so important since 75% of the polyps are of regenerative nature and only 2% appear to be primary malignant. 2) Control of bleeding: endoscopic control of bleeding is of high value as acute primary procedure. In the author's experience the modified use of electrocoagulation is preferable to the laser beam technique since it is less expensive and more mobile. 3) Endoscopic papillotomy and removal of stones: 10.9% complications were observed in 647 papillotomies, pancreatitis (2.6%) and bleeding (2.5%) being the most important. A mechanical lithotriptor is presented as a new device for lithotripsy in the common bile duct. So far 10 patients have been treated successfully by this technique. Other techniques like endoscopic prothetics or occlusion of the pancreatic duct are discussed including the author's preliminary experiences with these new techniques, that are still at experimental stage.

Adenoma↗
PubMed1982

[Diagnostic endoscopic assessment of the irritable colon syndrome (author's transl)].

The diagnosis of irritable colon was found in about 50% of 227 patients who showed increased colonic contractions at colonoscopy. In 1240 patients without unusual motility of the colon during colonoscopy this diagnosis was made only in every twelfth case. Increased contractions of the colon observed during colonoscopy are thus a symptom of the irritable colon. When clinical complaints are taken into account this symptom has a diagnostic value of 90%. However, it is not pathognomonic for functional intestinal complaints as it does not occur in all patients with irritable colon and it can also be demonstrated in patients without evidence of functional gastrointestinal problems.

Colonic Diseases, Functional↗
PubMed1982

[Treatment of chronic constipation with swelling substances].

In 20 patients with chronic constipation and, in many cases, years of laxative abuse, in a prospective and randomized study, treatment with new, specially prepared swelling substances administered at the recommended doses, was carried out after first stopping the use of laxatives. After only one week of this treatment, a marked increase in the weight of the stools, and a reduction in stool transit time (p less than 0.05 in each case) were observed.

Adult↗
PubMed1982

Operative endoscopy today.

Operative endoscopy permits therapeutic measures to be carried out that spare the patient major surgery. In its narrower sense, operative endoscopy was "inaugurated" with total biopsy of polyps. A complication occasionally seen with polyp-ectomies, namely haemorrhage, provided the impetus for developing endoscopic haemostasis using the laser beam and the electro-hydro probe. The possibility of cannulating the papilla of Vater and carrying out ERCP permitted the endoscopist not only to visualize concrements in the common bile duct, presenting as filling defects in the contrast material column-but also, when in a prepapillary location, to feel them with the tip of the catheter. The prepapillary concrement was, as it were, a sort of provocation for the diagnostic endoscopist. His response was to construct a simple papillotome, with the aid of which the roof of the papilla of Vater could be slit. In general, after papillotomy bile duct stones pass spontaneously, or can be extracted. In principle it is possible to destroy stones which cannot pass by employing pressure waves in the common bile duct induced by spark discharge in a liquid medium, or to reduce them in size by means of locally introduced dissolving agents. A relatively new branch of operative endoscopy involves interventions that might be described as prosthetic endoscopy. This includes the passing of plastic tubes down an oesophagus constricted by tumor growth, and the introduction of drainage tubes into the biliary system. Foreign body extraction, concerned primarily with swallowed objects located in the stomach, is an older but still very useful possibility of operative endoscopy.

Ampulla of Vater↗
PubMed1982

Endoscopic ultrasonography--technique, orientation and diagnostic possibilities.

40 patients were examined by peroral endoscopic ultrasonography with two new prototypes (Prototype II and III, Olympus Optical Co., Tokyo, Japan). Indications were various intestinal diseases. Topographical orientation was facilitated by standard positions of the instrument. The organs identified included liver, gall bladder, common bile duct, pancreas, spleen and kidneys. Pathological lesions of the organs mentioned were characterized by the echo pattern known from external ultrasonography. At present endoscopic ultrasonography is not a routine method but may provide additional information to peroral endoscopy and external ultrasonography without replacing these methods.

Adult↗
PubMed1982

Clinical application of a new mechanical lithotripter for smashing common bile duct stones.

After endoscopic papillotomy, the extraction of large stones is often very difficult. In numerous cases, it proves impossible to remove large concretions using conventional methods. On account of technical problems, electro-hydraulic lithotripsy was unable to fulfill all the hopes placed in it. A possible alternative method is that of mechanical lithotripsy. Initial clinical experience gained in 8 patients with large stones in the common bile duct, has shown that, with the aid of the technically simple procedure, it is possible to extract such large concretions, too.

Endoscopes↗
PubMed1982

Experimental evidence for an "internal leak" of cat gastric mucosa after stimulation with histamine and carbachol.

Numerous factors are involved in the pathogenesis of gastric ulcer. Possibilities under discussion are acid back diffusion, a reduction in the quality of the gastric mucus, and vascular factors that give rise to local ischemia. One hypothetical model presented for consideration, is based on the notion of an "internal leak", as a result of which acid escapes out of the parietal cells directly into the interstitium. Using the cationic dye acridine orange in cats, it has been possible to show, in particular after prior stimulation with stimulation with histamine and carbachol, but not with pentagastrin, that a microfocal accumulation of the dye in the interstitium can indeed be found. Under conditions of hypoxia, this phenomenon was not observed. In view of the specific properties of the dye, it may be concluded that, under certain conditions, acid substances can indeed diffuse out of the parietal cells into the interstitium. this animal model offers distinct findings compatible with the pathogenetic concept of an "internal leak".

Acridine Orange↗
PubMed1981

[Treatment of Crohn's disease with metronidazole (author's transl)].

The therapeutic effect of metronidazole, alone or in combination with the basic treatment schedule of corticosteroids, salazosulphapyridine or dietary formula was analysed retrospectively for 34 patients with active Crohn's disease who had previously been treated without success on the basic schedule. Clinical remission was achieved in all ten patients with highly florid Crohn's disease but no fistulae, regardless of whether metronidazole was given alone or in combination with the basic treatment regimen. Complete closure of the fistulae was achieved in 12 or 24 patients with fistulae, while marked regression of fistulae secretion occurred in a further five. It is concluded that metronidazole is of value particularly in cases resistant to basic treatment or with fistulae.

Adolescent↗