Search PubMed⌕ Search

Biomedical subjects

L Safrany

Publications and source records attributed to L Safrany.

At least 37 records · Page 2Linked to original sources
PubMed1980

[Endoscopic papillotomy for acute pancreatitis caused by biliary disease (author's transl)].

In 15 patients with acute pancreatitis caused by biliary disease endoscopic sphincterotomy was performed after diagnostic ERCP. All patients had a history of symptoms pointing to long-standing biliary disease, such as typical right-sided upper abdominal pain, signs of biliary stasis, and jaundice. An impacted solitary ampullar stone was demonstrated in eight patients while in seven several stones were found in the biliary tract. In one patient pancreaticogram also revealed a gall-stone which had slipped in Wirsung's duct. After endoscopic sphincterotomy and extraction of stone rapid and marked improvement occurred in all 15 patients and the biochemical abnormalities were restored towards normal. All patients became pain-free immediately after the procedure. The markedly raised levels of serum-alpha-amylase (mean of 21 700 U/l immediately before the procedure) fell tonormal values within 48 hours (400--3000 U/l). Endoscopic sphincterotomy is thus an alternative to early operation in acute pancreatitis of biliary origin.

Ampulla of Vater↗
PubMed1980

Endoscopic sphincterotomy in patients with Billroth II gastrectomy.

We attempted endoscopic sphincterotomy in 35 patients previously subjected to Billroth II gastrectomy, and succeeded in 23 of them. It is often difficult to pass the instrument along the afferent loop and the sphincterotomy incision is seldom placed in an optimal position. Although we had complications in only 2 patpients, it is likely that spincterotomy carries a higher risk in Billroth II gastrectomy patients. It should therefore be reserved for patients who are at high risk for surgery.

Ampulla of Vater↗
PubMed1980

Intraduodenal manipulations of the common bile duct.

The history of the development and technique of endoscopic sphincterotomy are discussed. This includes a review of 796 successful sphincterotomies out of 838 attempts. The indications for sphincterotomy were choledocholithiasis in 632 patients, stenosis of the papilla of Vater in 136, periampullary tumor in 24, and stones in the main pancreatic duct in 4 patients. Of 632 patients with choledocholithiasis, 234 passed the stone spontaneously, and 358 has the stone extracted. Residual stones remained in 40 patients. Complications, such as bleeding, retroperitoneal perforation, pancreatitis, cholangitis, and impaction of the Dormia basket, were noted. This indicates a morbidity of 6.9 percent. Fifteen patients required laparotomy. The overall mortality was 1.13 percent. Endoscopic laparotomy. The overall mortality was 1.13 percent. Endoscopic sphincterotomy is a relatively safe and effective method for treatment of extrahepatic cholestasis. The complication rate for patients at high risk is significantly lower than for patients undergoing conventional transabdominal operations.

Aged↗
PubMed1978

Endoscopic treatment of biliary-tract diseases. An international study.

Data on endoscopic sphincterotomy from 15 gastroenterology centres with very wide experience show that 3618 out of 3853 (93.%) attempts at the procedure were successful. The main indication for sphincterotomy was choledocholithiasis (3070, or 84.9% cases). After sphincterotomy the stones passed spontaneously or were removed in 2779 (90.5%) cases. Bleeding, cholangitis, pancreatitis, perforation, and stone impaction occurred in 254 (7.0%) cases; the mortality-rate was 1.4%. 83 (2.3%) cases required emergency surgery. Endoscopic sphincterotomy is increasingly replacing surgery in the treatment of choledocholithiasis.

Ampulla of Vater↗
PubMed1978

Radiation exposure in patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic papillotomy.

Radiation exposure was studied in 327 patients undergoing endoscopic retrograde cholangiopancreatography, or endoscopic papillotomy taking into account fluoroscopy time and incident area exposure. The mean fluoroscopy time was 238 +/- 152 seconds and the incident area exposure 3,730 +/- 2,790 R X cm2. These results were compared with standard exposures in upper GI series and colon examinations as found in the literature.

Adult↗
PubMed1978

Endoscopic retrograde cholangiography (ERC) in surgical emergencies.

Twelve patients, presenting with an acute abdomen of suspected biliary tract origin, had endoscopic retrograde cholangiography performed. Eight patients had either traumatic, spontaneous, or postoperative biliary tract fistulas with five leading to the peritoneal cavity, one to the colon, one to the bronchial tree, and one to the liver parenchyma from a ruptured gall-bladder. Each was confirmed by endoscopic retrograde cholangiography. Four patients with jaundice, following traumatic rupture of the liver, had a pathological communication between the intrahepatic biliary tracts and the hepatic vascular system. It is concluded that ERC is a reliable method for obtaining precise localization of biliary tract problems in surgical emergencies both pre- and post-operatively.

Adolescent↗
PubMed1978

[Hemobilia and bilhemia complicating liver trauma (author's transl)].

Hemobilia and bilhemia are typical complications of liver trauma which have been found more often during the last years. Today gastroduodenoscopy, retrograde cholangiography, selective angiography and scintillation scanning of the liver make an exact diagnosis possible. In the case of hemobilia a ligature of the corresponding artery might be successful, whereas in the case of bilhemia only partial resection of the liver leads to success.

Adolescent↗
PubMed1978

[Juxtapapillary diverticula of the duodenum and bilio-pancreatic symptoms (author's transl)].

Juxtapapillary diverticula of the duodenum are more frequent than has been assumed up to now. Among 2100 patients undergoing duodenoscopy 135 duodenal diverticula have been found. These diverticula may cause symptoms of diverculitis as well as of bilio-pancreatic disease. Such diverticula ought to be treated by surgery. In our department diverticula are turned inward, or a papillo-diverticulotomy is done depending upon the localization of the diverticula.

Cholangitis↗
PubMed1977

[Therapeutic endoscopic retrograde cholangiography (author's transl)].

Endoscopic papillotomy is a further development of endoscopic cholangiography. This therapeutic procedure was successful in 516 (94.7%) of 545 cases. Choledocholithiasis (405 cases) and papillary stenosis (97) were the main indications for the procedure. Of 405 patients with choledocholithiasis, 376 (93%) are now free of stones. There were 38 (7.4%) complications and 5 (1%) of these had a lethal outcome with (11) (2%) requiring emergency laparotomy. Cholangitis was the most serious complication. It is becoming increasingly evident that the endoscopic papillotomy is replacing reoperation in many cases of choledocholithiasis.

Cholangiography↗
PubMed1977

[Diverticula of the stomach - diagnosis of their importance (author's transl)].

Gastric diverticula may be due to dilatation or traction. 75% are found in the fundus, 15% in the prepyloric antrum. In 10% they were situated elsewhere. Symptoms are unspecific. Radiography has to be combined with endoscopic investigation of their nature. Smaller diverticula are mainly treated conservatively, the larger ones will require surgery because of chronic symptoms and complications.

Diagnosis, Differential↗
PubMed1977

Duodenoscopic sphincterotomy and gallstone removal.

Duodenoscopic sphincterotomy was attempted in 265 patients. The procedure was successful in 243 patients (92%). Indications for sphincterotomy were: 185 patients with choledocholithiasis, 52 patients with papillary stenosis, and 6 patients with ampullary carcinoma. The clinical and biochemical evidence of cholestasis resolved in 222 of the 243 successful patients (91%). Complications consisting of hemorrhage, perforation, pancreatitis, cholangitis, and instrumental injury resulted in three deaths, an over-all mortality of 1.2%. Emergency laparotomy was required in 6 cases (2.5%). Duodenoscopic sphincterotomy is a relatively safe and effective means of relieving certain instances of extrahepatic cholestasis. The complication and mortality rates appear lower than those with equivalent conventional surgical techniques.

Adult↗
PubMed1977

[Bronchobiliary fistula. Pathogenesis, diagnosis, therapy].

The case demonstrated shows the pathomechanism of bronchobiliary fistula. In most cases, bronchobiliary fistulae are caused by stenosing lesions of the common bile duct. For diagnosis the combined cholangio-bronchography is the preferred method. Removal of the obstructing lesion is the aim of operative treatment. Usually spontaneous healing of the bronchobiliary fistula results.

Adult↗
PubMed1975

Endoscopic papillotomy and removal of gall stones.

Endoscopic papillotomy was attempted in 59 patients with extrahepatic obstruction of the biliary duct system and was actually performed in 50 patients. A special high-frequency diathermy knife was introduced via a duodenoscope into the terminal common bile duct and the roof of the papilla was incised. In 33 out of 39 patients with choledocholithiasis the stones passed into the duodenum spontaneously or were removed endoscopically. Papillary stenosis without ductal stones was successfully treated with this method in eight out of 11 patients. One perforation of the duodenocholedochal junction occurred and was repaired surgically. Endoscopic papillotomy and stone extraction is a relatively safe and effective method of treating extrahepatic jaundice.

Aged↗
PubMed1975

[Hemobilia (author's transl)].

Hemobilia is a syndrome caused by hemorrhage into the biliary ducts. It is characterized by colicky pains, jaundice, and intestinal bleeding; a correct diagnosis of this syndrome is made rather rarely. The most common cause is trauma; inflammatory or tumorous disease of the liver and bile duct system, bile stones and aneurysms of the hepatic artery are rarer causes. The diagnosis can be established and the arterio-biliary fistula localized by selective arteriography. A case is described, which shows, that, in addition, duodenoscopy with retrograde cholangiography is of diagnostic value. Other helpful diagnostic procedures are: splenoportography, liver scanning, and intraoperative cholangiography. Therapy must be surgical exclusively; palliative operations lead to high rates of relapses and letality. Best results are achieved by ligature of the hepatic artery in cases of central, or by partial resection of the liver in cases of peripheral localization of the fistula.

Accidents, Traffic↗
PubMed1975

[Hemobilia following liver injury].

A case of post-traumatic haemobilia is presented and the diagnostic and therapeutic aspects of this condition are discussed. In addition to coeliacography, spleno-portography and scan, retrograde endoscopic cholangiography is a valuable diagnostic technique. Treatment is operatively, by drainage and haemostasis of the affected area with liver resection or by ligation of the afferent arteries. In the case presented ligation of the left hepatic artery was successful.

Adolescent↗