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Biomedical subjects

L Safrany

Publications and source records attributed to L Safrany.

At least 19 recordsLinked to original sources
PubMed1992

Aerobilia and hypomotility of the sphincter of Oddi in a patient with chronic intestinal pseudo-obstruction.

A 50-year-old woman with a typical history of chronic idiopathic intestinal pseudo-obstruction was admitted to hospital because of an acute episode of abdominal cramps, nausea, and vomiting. The diagnosis of chronic idiopathic intestinal pseudo-obstruction had been established in this patient who had malnutrition and extreme weight loss as a result of severe malabsorption syndrome. The abdominal roentgenogram showed a typical hypotonic intestine with an enlarged stomach and distended intestinal loops with the radiological signs of an ileus. In addition to former episodes, there was also a transient aerobilia. The patient had not undergone biliary surgery or endoscopic sphincterotomy. To investigate the cause of the findings, endoscopic retrograde cholangiopancreatography and endoscopic manometry of the sphincter of Oddi were performed. The endoscopy showed the stomach and duodenum with a wide and dilated lumen and no spontaneous motility. Endoscopic manometry of the biliary tract and the sphincter of Oddi showed several abnormalities compared with a group of normal volunteers or patients who were examined via biliary manometry for other reasons. There was a low basal pressure (3.5 mm Hg) in the sphincter of Oddi together with low-amplitude phasic contractions (25-30 mm Hg), but the contraction frequency was in the normal range. Further investigations of the motility of the gastrointestinal tract in this patient showed diffuse esophageal spasms and a markedly delayed gastric emptying. The findings of biliary manometry in this patient suggest involvement of the sphincter of Oddi and the biliary system in chronic idiopathic pseudo-obstruction.

Air↗
PubMed1988

Duodenoscopic sphincterotomy in patients with gallbladders in situ: report of a series of 1272 patients.

We present a prospective, unrandomized, uncontrolled series of 1272 patients in whom endoscopic sphincterotomy (ES) was performed, and who had not previously undergone cholecystectomy. These patients were culled from our combined experience of a total of 4177 patients in whom ES was performed over the last 13 yr. Of the group reported here, 1208 patients had demonstrable gallbladder stones, and 64 had acalculous gallbladders. The group included 896 females and 396 males whose mean age was 73.3 yr and who ranged from 17 to 101 yr old. Cholangitis was present in 317 patients (25%), and gallstone pancreatitis in 134 (10.5%) patients. After sphincterotomy, 109 patients (8.6%) developed cholecystitis; 23 developed this within 48 h, and 86 developed this within 10 days of the procedure. Emergency surgery was performed on 25 of these patients, and 84 responded to medical therapy alone. Two deaths occurred within 30 days of sphincterotomy (0.15%), in both cases following emergency surgery in elderly patients. One hundred-eight patients underwent elective cholecystectomy within 3 yr of their sphincterotomy because of recurrent symptoms referrable to the biliary tract. In a subset of 337 patients in whom long-term followup was possible, two patients died of complications related to recurrent cholecystitis, both at approximately 2 yr after sphincterotomy. Although followup was less than optimal in this large series of patients, the data presented here suggest that an intact gallbladder is not a contraindication to ES in the management of common bile duct stones, and that the morbidity and mortality of ES compare favorably over the long and short term with surgical management.

Adolescent↗
PubMed1983

[Endoscopic bile duct drainage in malignant obstructive jaundice--an alternative procedure to palliative surgery].

74 patients suffering from malignant bile duct obstruction were treated by endoscopic endoprosthesis placement. Improvement and standardization of the technique resulted in successful decompression in 97% of the cases. Also, the complication rate could be reduced to 6.9% (fatal complications, 4.6%). The mean survival time after decompression was 4.5 months, 25 patients of them being still alive. The endoprosthesis had to be replaced after an average of 2.3 months due to occlusion. The endoscopic bile duct decompression is better than surgical palliation in patients with proximal bile duct obstruction. At present, endoscopic endoprothesis placement can be recommended as an alternative method for the palliation of malignant bile duct obstruction.

Aged↗
PubMed1983

[Treatment of duodenal ulcer with synthetic depot secretin - a double-blind study].

63 inpatients with duodenal ulcer disease were treated with either depot-secretin or placebo. Two different secretin-regimens were used. In group I 18 patients were given secretin twice daily. 11 ulcers from a total of 19 ulcers healed within 3 weeks. In group II 23 patients were given secretin once daily. 21 out of 28 ulcers healed within 3 weeks. In the placebo-treated group 24 ulcers were observed in 22 patients. Of these 15 healed within 3 weeks. There was no statistical difference in the healing rate between the 3 groups. However, depot-secretin significantly improved typical symptoms. Analgetics were used less frequently. Serious side effects did not occur.

Adult↗
PubMed1983

[Endoscopic diagnosis and therapy of papillary tumors].

Endoscopic papillotomy (EPT) allows biopsy of tumors of the Vater's papilla using coils or forceps. EPT is a preoperative diagnostic procedure in patients with carcinoma of the papilla, who can be operated upon, a palliative procedure in patients which cannot be operated upon anymore, and a curative procedure in patients with benign tumors which cannot be operated upon because of general risk factors. EPT is also a preparatory procedure for internal drainage of the bile duct system by endoscopy.

Aged↗
PubMed1982

[Endoscopic transpapillary bile duct drainage in malignant obstructive jaundice].

Endoscopic biliary duct drainage was performed in 54 patients with obstructive jaundice caused by papillary carcinoma (n = 4), periampullar carcinoma (n = 4), carcinoma of head of pancreas (n = 16), primary biliary duct carcinoma (n = 14), biliary bladder carcinoma (n = 14) and hilar lymph node metastases (n = 2) using a bilioduodenal endoprosthesis. Drainage was successful in 45 cases; serum bilirubin decreased rapidly, well-being improved, appetite and weight increased. The average survival time was 4.8 months. The initially high rate of complications, mainly due to cholangitis, with a mortality rate of 9.3% could be reduced drastically after use of a duodenoscope with a 3.7 mm bore instrumentation canal enabling insertion of well-draining wide-lumen endoprostheses. Drainage should only be used in non-resectable tumours, general inoperability or for preoperative relief of biliary ducts in jaundice and prospective curative surgical intervention. As results improve with mounting experience it may be expected that endoscopic biliary duct drainage will replace palliative surgery, especially in elderly patients at risk.

Aged↗
PubMed1981

[Spontaneous migration of large stones from the bile duct (author's transl)].

Spontaneous migration of bile-duct stones through the papilla into the intestine was directly observed in two patients with choledocholithiasis. The mechanism of such spontaneous migration lies in the development of a pressure necrosis at the papilla causing a tear in its pore. Spontaneous migration of stone from the common bile duct can be assumed when endoscopic retrograde cholangiopancreatography reveals a balloon-shaped swollen papilla with a torn pore, and previously observed obstructive jaundice regresses in the presence of stone-free, though perhaps somewhat dilated, bile passages.

Aged↗
PubMed1981

Complications of endoscopic sphinecterotomy and their treatment.

Despite the careful observance of standard precautions during endoscopic sphincterotomy, serious complications are sometimes unavoidable and these may require various forms of treatment. Surgical intervention is necessary for fulminating pancreatitis, acute arterial hemorrhage, and retroperitoneal abscess. The endoscopic insertion of a drainage tube into the common bile duct can serve to overcome biliary obstruction due to cholangitis secondary to stone impaction, Dormia basket impaction or blood clot. The obstruction can be removed electively either endoscopically or surgically in a symptom-free interval. Uncomplicated perforation can be treated by parenteral feeding and naso-gastric suction. Acute pancreatitis may require further intensive care procedures such as peritoneal or hemodialysis and early intermittent positive pressure respiration. By using these means the mortality rate due to ES is reduced to 0.5%.

Ampulla of Vater↗
PubMed1981

A preliminary report: urgent duodenoscopic sphincterotomy for acute gallstone pancreatitis.

Eleven patients wtih gallstone-related acute pancreatitis underwent urgent duodenoscopy and diathermy sphincterotomy; six had stones impacted at the papilla of Vater, and the remainder had stones in the bile duct. One patient had a gallstone in the pancreatic duct. Endoscopic removal of the duct stones resulted in a prompt, persistent clinical and biochemical improvement, except in one patient who had been referred from another hospital with a pseudocyst 3 weeks after the onset of illness. Pancreatography results were remarkably normal in the remaining patients. Use of emergency biliary decompression in patients with acute gallstone-related pancreatitis remains controversial, and the indications need clarification. However our results justify further evaluation of duodenoscopic sphincterotomy as an alternative to surgery.

Acute Disease↗