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Biomedical subjects

L Greiner

Publications and source records attributed to L Greiner.

At least 37 records · Page 2Linked to original sources
PubMed1997

Safety and efficacy of repeated shockwave lithotripsy of gallstones with and without adjuvant bile acid therapy.

BACKGROUND & AIMS: The value of adjuvant bile acid dissolution therapy after extracorporeal shockwave lithotripsy (ESWL) of gallbladder stones is under debate. A double-blind, randomized, multicenter trial was conducted to determine the safety and efficacy of repeated ESWL with and without adjuvant bile acid therapy. METHODS: At five centers, 153 patients with gallstones and good gallbladder emptying were randomized to undergo up to six high-energy lithotripsy sessions combined with ursodeoxycholic acid (UDCA, 750 mg/day; n = 77) or placebo (n = 76). RESULTS: Six months after the initial treatment, 77% of patients with small single stones (< or = 20 mm in diameter), 60% with large single stones (> 20 mm in diameter), and 41% with multiple stones were free of stones. Administration of UDCA had no effect on stone disappearance in the whole study group but tended to improve stone disappearance rates in patients with large single stones and tended to decrease biliary adverse effects in patients with multiple stones. CONCLUSIONS: Repeated high-energy ESWL without adjuvant bile acid therapy represents a safe and effective treatment in patients with small single stones and good gallbladder emptying. In patients with large single stones and multiple stones, adjuvant bile acid therapy may be beneficial.

Adjuvants, Pharmaceutic↗
PubMed1997

Argon plasma coagulation (APC) in gastroenterology: experimental and clinical experiences.

BACKGROUND: Diathermy procedures are indispensable in interventional endoscopy. Argon beam coagulation is an innovative no-touch electrocoagulation technique in which high-frequency alternating current is delivered to the tissue through ionized argon gas. METHOD AND PATIENTS: Before clinical application, we conducted in-vitro studies to investigate the depth and diameters of tissue coagulation in fresh operative specimens from the stomach, small intestine and colon. Five different power/gas flow settings between 40 and 155 W and 2 and 7 l/min were used. The impact time (1-10s) and the incident angle of the probe (45 degrees and 90 degrees) were also varied. The maximum depth of necrosis was 2.4 mm, the maximum diameter 1.1 cm. No perforation occurred even in critical areas such as the colon and duodenum. We therefore performed argon beam coagulation in 66 consecutive patients. Two power/gas flow settings of 40 and 70 W and 2 and 3 l/min, respectively, were used. The impact time and incident angle were varied individually. RESULTS: In 49 of the 50 patients with oozing haemorrhage from angiodysplastic lesions, polypectomy sites, erosions or ulcers or oozing of blood due to vascular penetration by tumours, definitive haemostasis was achieved in one to two sessions. In all 11 patients with residual sessile adenoma tissue, complete removal was possible. Oesophageal patency was restored in all five patients with stenosing tumours. In one patient with angiodysplasia of the caecal pole, an asymptomatic accumulation of gas in the submucosa was observed which resolved spontaneously. In two patients with extensive oesophageal carcinoma, there was a transitory--also asymptomatic--accumulation of gas in the mediastinum and peritoneal cavity but no evidence of perforation. CONCLUSION: Argon plasma electrocoagulation is an effective and relatively low-cost alternative to laser therapy in gastrointestinal endoscopy.

Adenoma↗
PubMed1997

[Non-operative management of pancreatitis with splenic involvement].

Pancreatitic pseudocysts of the spleen are rare events. We report two cases of conservative management of splenic involvement in pancreatitis by ultrasound-guided aspiration. The first patient was admitted with clinical and biochemical signs of acute exacerbation of chronic pancreatitis. The ultrasound examination showed a subcapsular anechoic zone in the spleen as well as pancreatic pseudocysts. The laboratory examination of the fluid obtained by ultrasound-guided aspiration confirmed the presence of an intrasplenic pancreatitic pseudocyst which disappeared completely after a second percutaneous aspiration. The second patient was admitted with acute exacerbation of chronic pancreatitis and septic symptoms caused by an abscess near the left lobe of the liver. After successful surgical drainage of the abscess the patient developed an expanding anechoic subcapsular fluid zone in the spleen. Quantitative decompression by ultrasound guided fine needle-aspiration confirmed the pancreatitic origin of the lesion which vanished within a few days without further treatment. We conclude that fine-needle aspiration of splenic pseudocysts under ultrasound control permits a differential diagnostic distinction from splenic abscess or hematoma and accelerates healing. There is thus a nonsurgical option for treatment of pancreatitic intrasplenic pseudocysts, provided that the patient is under close clinical observation.

Adult↗
PubMed1996

[Endoscopic therapy in acute hemorrhage caused by duodenal diverticula].

HISTORY AND CLINICAL FINDINGS: A 70-year-old previously healthy woman had been feeling nauseous for one day and had passed several liquid tarry stools. A barium meal previously done as an out-patient had shown a duodenal diverticulum 3.5 cm in diameter with marked contrast-medium retention. Her general condition was impaired, her skin pale and cold, while heart rate and blood pressure were normal. Rectal examination confirmed tarry stool and thus suggested upper gastrointestinal bleeding, the contrast-medium retention pointing to the duodenal diverticulum as a likely site. INVESTIGATIONS: Haemoglobin concentration was 9.1 g/dl, the haematocrit 26.6%. Total protein was reduced to 4.4 g/dl. Esophagogastroduodenoscopy (performed about 10 hours after the barium meal) showed erosion at the duodenal bulb and contrast retention in the juxtapapillary diverticulum, but no acute bleeding was discovered. TREATMENT AND COURSE: Repeat endoscopy on the following day revealed acute bleeding (Forrest stage Ia) from an arterial stump in the diverticulum. It was stopped with local injection of adrenaline (6 ml of 1:10,000 solution) and fibrin glue, but the injections had to be repeated twice. Another endoscopy 30 days after the first showed merely a mucosal scar. CONCLUSION: Early endoscopy enables one to make the diagnosis and to provide minimally invasive treatment of bleeding from a duodenal diverticulum.

Acute Disease↗
PubMed1996

[The sono-capsule: a new method for measuring gastrointestinal motility].

PURPOSE: We developed a noninvasive procedure using ultrasound and a specially designed capsule to permit determination of transit times in the gastrointestinal tract. METHODS: The ultrasound capsule consisted of a latex balloon of 1 cm diameter filled with water and containing a solid metal ball. After ingestion the marker was visualised in the gastrointestinal tract at defined intervals using conventional ultrasound machines. The various transit times were determined in 10 healthy volunteers. RESULTS: On account of its artifact-in-artifact structure (cystic configuration and reverberation), the ultrasound capsule was first detected in the stomach without any difficulty. During its further passage through the gastrointestinal tract the location of the capsule in the small and large bowel could be identified on the basis of the surrounding plicae circulares and haustrations. The mean oropyloric transit time was 2.4 hours; passage through the small bowel took 1.5 to 3 hours, and pyloro-anal transit times between 6 and 10 hours. CONCLUSION: the ultrasound capsule is a suitable method for investigating the gastrointestinal transport. It is non-invasive and does not expose the patient to radiation.

Adult↗
PubMed1996

[Extracorporeal shockwave lithotripsy (SWL) of common bile duct calculi without previous endoscopic papillotomy].

In 17 patients (8 men, 9 women; mean age 61.5 years) with problematic bile-duct stones (papilla endoscopically inaccessible, residual bile-duct stones after recent laparoscopic cholecystectomy or age below 25 years) the chances of successful treatment by ESWL without sphincterotomy were examined. In 15 patients with solitary stones measuring up to 14 mm "pulverization-ESWL" produced complete freedom from stones after spontaneous migration of fragments through the intact papilla. Only two patients with two ductal stones measuring up to 15 mm still had residual fragments in the bile duct after treatment. The ideal stone for ESWL without sphincterotomy is thus the solitary bile-duct stone measuring up to 14 mm. Before performing a high-risk sphincterotomy, before re-operation and in young patients one should therefore always examine whether ESWL without sphincterotomy is indicated.

Adolescent↗
PubMed1995

[Non-contact argon gas coagulation in flexible endoscopy of the gastrointestinal tract: in vitro studies and initial clinical experiences].

Diathermocoagulation is indispensable in interventional endoscopy. The argon beam coagulation represents an innovative electrocoagulation method, where high-frequency alternating current is conducted to tissues by ionized argon gas without contact. Before clinical application we performed in vitro studies to evaluate depth and diameter of tissue coagulation of fresh resectations from stomach, small intestine and colon. Power and gas flow were graduated in five steps from 40 to 155 W and from 2 to 7 l/min respectively. Coagulation time (1 s-10 s) and angle of the probe in relation to tissue surface (45 degrees, 90 degrees) were varied. The maximal depth of necrosis was 2.4 mm, the maximal diameter 1.1 cm. There was no perforation found, even in critical areas like colon and duodenum. Accordingly argon beam coagulation was performed in 41 consecutive patients. The power and gas flow were varied in two stages between 40 and 75 watts and 2 and 3 l/min respectively. Coagulation time and angle of the probe were handled individually. In 32 of the 33 patients with bleeding from angiodysplastic lesions or polypectomy sites, with oozing of blood from erosions or ulcers or with bleeding due to vascular penetration by tumors definitive hemostasis was achieved in one to two sessions. In all of the four patients with residual sessile adenoma tissue complete removal was possible. Esophageal patency was restored in all four patients with stenosing tumors. In one patient with angiodysplasia of the cecal pole an asymptomatic accumulation of gas in the submucosa was observed which cleared spontaneously. In two patients with extensive esophageal carcinoma there was a transitory--also asymptomatic--accumulation of gas in the mediastinum and peritoneal cavity but no reference to perforation. The non-contact argon electrocoagulation is in gastrointestinal endoscopy an effective and non-expensive alternative to laser-technique.

Adenomatous Polyps↗
PubMed1994

A program to measure new energetic particle nuclear interaction cross sections.

The Transport Collaboration, consisting of researchers from institutions in France, Germany, Italy and the USA, has established a program to make new measurements of nuclear interaction cross sections for heavy projectiles (Z > or = 2) in targets of liquid H2, He and heavier materials. Such cross sections directly affect calculations of galactic and solar cosmic ray transport through matter and are needed for accurate radiation hazard assessment. To date, the collaboration has obtained data using the LBL Bevalac HISS facility with 20 projectiles from 4He to 58Ni in the energy range 393-910 MeV/nucleon. Preliminary results from the analysis of these data are presented here and compared to other measurements and to cross section prediction formulae.

Cosmic Radiation↗
PubMed1994

[ESWL-therapy of pancreatic duct calculi].

In 23 patients suffering from pancreatic duct stones, extracorporeal shock wave lithotripsy (ESWL) was performed in combination with endoscopic sphincterotomy (EST). Calculi-disintegration and resolution of obstruction was achieved in all cases. Completely stone-free ducts were achieved in 7 patients, some peripheral asymptomatic stone material remained in 16. 8 patients became completely asymptomatic, 11 reported a marked reduction of their pain. 15 patients gained weight. No major complications were observed. ESWL combined with EST is a successful non-operative new treatment option in pancreatic stone disease.

Adolescent↗
PubMed1994

[Chronic mesenteric ischemia--a rare differential diagnosis of Crohn disease].

A 59-year-old patient was treated for six years assuming Crohn's disease. Recurrent segmental colitis, spontaneous perforation of the jejunum and chronic weight loss were suggestive of this diagnosis despite a missing typical histology, even in the resected part of jejunum. Only unspecific inflammatory changes were found. Typical angina abdominalis occurred late. Angiography showed a complete occlusion of the coeliacaxis and both mesenteric arteries. Only the slow progress of occlusion of the visceral arteries with extensive collateral circulation from iliacal arteries explains the absence of severe bowel infarction. After aortomesenteric bypass operation the patient is without any complaint.

Angiography↗
PubMed1993

Ultrasonography and biliary extracorporeal shock-wave lithotripsy.

The results of shock-wave treatment of gallbladder stones depend to a very high degree on the quality and expertise of ultrasonography applied before, during, and after shock-wave disintegration of the stones. Ultrasonography is decisive in evaluating the inclusion criteria; it is the method of choice for directing the shockwave energy at the stones and monitoring the disintegration process. It is the only diagnostic modality to really demonstrate the gallbladder being free from stones.

Bile Duct Diseases↗
PubMed1993

[Extracorporeal shockwave lithotripsy of problem bile duct calculi].

ESWL is a new gentle, very effective, poor-risk technique in treatment of extrahepatic problematic bile-duct stones. This method might substitute surgical choledochotomy to a great extent. ESWL is a new therapeutic alternative to achieve nonoperative freedom of stones or, at least, to treat biliary obstruction in intrahepatic bile-duct stones, which are not treatable by endoscopic operative methods.

Anastomosis, Roux-en-Y↗
PubMed1993

[Extracorporeal shockwave lithotripsy of gallbladder calculi].

Shockwave disintegration of gallbladder stones with lythic therapy of residual fragments is successful when all criteria of patient- and stone-selection, shockwave application and lysis are fulfilled. The "Four-S-stones" proved to be the best candidates: solitary, symptomatic, sonolucent in a sufficiently contractile gallbladder. The rate of complications is low. Stone recurrence rate (10 to 15% after three years) is much lower as in previous studies using lythic therapy only. The new therapeutic approach to gallbladder stone disease with fragmentation, spontaneous fragment-clearance and lysis of residual fragments is--as the only truly non-invasive procedure--for 10 to 20% of the patients an alternative equal to operation.

Chenodeoxycholic Acid↗