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Biomedical subjects

M Cremer

Publications and source records attributed to M Cremer.

At least 145 records · Page 8Linked to original sources
PubMed1987

Palliative endoscopic management of obstructive esophagogastric cancer: laser or prosthesis?

One hundred forty-four patients with unresectable malignant strictures of the upper digestive tract were managed by palliative endoscopic methods: 116 by intubation and 28 by YAG laser phototherapy. The success rate was 95% for intubation and 100% for laser. The morbidity rate was 13.8% for intubation (perforation 7.8%, bleeding 3.4%, and aspiration pneumonia 2.2%) and 3.6% (one perforation) for laser. The mortality rate was 4.3% for intubation and 0% for laser. Specific indications for intubation were esobronchial fistulas, extensive strictures, and very long stenotic lesions. Very high cervical strictures and nonocclusive asymmetrical tumors were better treated with laser. In select cases, combined therapy can be useful. We conclude that both methods are highly efficient in restoring patency and relieving dysphagia. Further large scale randomized trials are necessary to compare functional results and survival rate.

Aged↗
PubMed1987

Endoscopic management of a post-traumatic biliary fistula.

A number of techniques of surgical endoscopy have been used in the management of a post-traumatic biliary fistula. The endoscopic sphincterotomy with placement of a perfused nasobiliary catheter, followed by the insertion of a biliary stent allowed the fistula to dry out. A secondary stricture of the left hepatic duct was treated by endoscopic internal drainage after the insertion of a transhepatic guidewire by an epigastric route. This kind of combined transhepatic and endoscopic procedure is useful in some difficult cases.

Adult↗
PubMed1987

300 mg nizatidine at night versus 300 mg ranitidine at night in patients with duodenal ulcer. A multicentre trial in Europe.

Patients (859) from six countries were randomized into an endoscopically controlled double-blind trial. The objective of this study was to compare the efficacy and safety of nizatidine 300 mg nocte with ranitidine 300 mg nocte in the therapy of duodenal ulceration. Patients fulfilling the entry criteria and completing the protocol numbered 777 (388 nizatidine, 389 ranitidine). Endoscopy was performed on entry and at 4-week intervals (up to 8 weeks) until the ulcer healed, except in Germany where endoscopy was also performed after 14 days. Both groups appeared well matched for population demographics, duodenal ulcer history, previous therapy and pre-study symptomatology. Overall healing rates in the nizatidine group compared favourably with the ranitidine group at 4 weeks (nizatidine 81%, ranitidine 80%) and 8 weeks (nizatidine 92%, ranitidine 93%). Data from Germany alone showed similar ulcer healing rates after 2 weeks therapy (nizatidine 60%, ranitidine 64%). Although there were no differences between or within the treatment groups, overall ulcer healing was significantly impaired (p less than 0.05 or less) in patients with a large ulcer (greater than 15 mm), a family history of peptic ulcer disease, verified disease or greater than 5 years duration, or heavy smokers (greater than 20 cigarettes/day). Age did not influence healing. Overall healing rates were significantly influenced by country of patient origin, being higher in Germany, and lower in Belgium (p less than 0.001). After 2 weeks therapy, about 60% of the nizatidine and ranitidine treated patients were pain free, while 4 weeks therapy was associated with relief of all symptoms in 72% of patients and relief of night pain in more than 90%. Antacid consumption reduced at a similar rapid rate during the study. Events were reported equally in both treatment groups, events compatible with peptic ulcer disease predominating. Events associated with study termination appeared related to documented disease or protocol violations. Monitoring of laboratory data suggested no significant haematological or biochemical abnormalities in the nizatidine group. Nizatidine 300 mg nocte appears to be as effective as ranitidine 300 mg nocte in both ulcer healing and symptomatic response.

Adult↗
PubMed1987

Nizatidine versus ranitidine in gastric ulcer disease. A European multicentre trial.

Two hundred and seventy five patients from six countries were randomized into an endoscopically controlled, eight-week, double-blind, study. The objective of this investigation was to compare the efficacy and safety of nizatidine, administered as either a single (300 mg nocte) or twice daily (150 mg B.D.) dose, with ranitidine 150 mg twice daily, in the therapy of benign gastric ulceration. Two hundred and fifty-two patients fulfilled entry criteria and completed the protocol (80 nizatidine 150 mg B.D.; 89 nizatidine 300 mg nocte; 83 ranitidine 150 mg B.D.). Endoscopy was performed on entry and at four-week intervals until the ulcer healed. The diagnosis of benign ulceration was always supported by endoscopic histology and/or cytology. On entry into the study, both groups appeared well matched (i.e. for population demographics, duodenal ulcer history, previous therapy and pre-study symptomatology), except for epigastric day pain which was significantly less in the ranitidine group (p = 0.020). Overall gastric ulcer healing rates were similar in the three groups at four weeks (nizatidine B.D. 66.2%: nizatidine nocte 65.2%: ranitidine B.D. 63%) and at eight weeks (nizatidine B.D. 90%: nizatidine nocte 86.5%: ranitidine B.D. 86.7%). Healing was not consistently influenced by country of origin or smoking. After four weeks of therapy, 66% (nocte dose) to 68% (B.D. dose) of nizatidine treated patients were symptom free, while 93% (nocte dose) to 95% (B.D. dose) were free of night pain. Events were similar in the three treatment groups, and the majority were gastro-intestinal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Comparison of elastase-1 with amylase, lipase, and trypsin-like immunoreactivity in the diagnosis of acute pancreatitis.

Serum elastase-1, amylase, lipase, and trypsin-like immunoreactivity were measured in a group of 17 consecutive patients with acute pancreatitis. When assayed within 24 h of the onset of symptoms, all enzymes were found to be elevated, thus showing similar sensitivity. Elastase-1 did not improve the diagnostic score of the other enzymes studied. Owing to their much quicker and less expensive determinations, amylase and lipase should be considered the best initial markers of pancreatic injury. However, during the course of pancreatitis, amylase and in a lesser degree lipase returned to normal in more cases than elastase or trypsin; both were still elevated in 90% of the patients 10 days after the onset of the symptoms. Thus, trypsin and/or elastase-1 should be reserved for cases of doubtful or delayed diagnosis. The specificity and the positive predictive value of these enzymes need to be evaluated.

Acute Disease↗
PubMed1987

Hepatic vascular disease after kidney transplantation: report of two cases and review of the literature.

Severe hepatic vascular disease developed in two patients 4 and 8 years after kidney transplantation, while receiving combined immunosuppressive therapy with prednisone and azathioprine. Portal hypertension and marked liver failure were observed in both cases. The diagnosis was established by histological examination of liver biopsies showing typical veno-occlusive disease of the liver associated with peliosis in both cases. Azathioprine was discontinued. Two years later one patient was asymptomatic and liver function tests were normal. The second patient died 3 years later from liver failure. Early recognition of hepatic vascular disease arising in kidney transplant recipients would be of utmost importance, as substitution of another immunosuppressive agent for azathioprine could halt the process leading to portal hypertension.

Adult↗
PubMed1987

Bleeding esophagogastric varices: an endoscopic study.

Among 857 patients admitted from October 1977 to December 1984 with acute upper gastrointestinal hemorrhage, 165 (19.5%) had endoscopically proved esophageal or gastric varices. Among this group, varices were considered as the actual bleeding lesion in only 83 (9.7%). Stigmata of variceal bleeding were observed in 76 (92%) including 35 venous spurts, 12 venous oozes, 20 adherent clots, and 14 "platelet aggregates." In only seven cases, variceal rupture could only be presumed, because no other lesion was present. In the other 82 patients, a lesion other than varices was the bleeding source, mostly peptic ulcers (32 = 38%) and erosive gastritis (30 = 36%). One-third of the patients with bleeding varices required more than one endoscopy to provide evidence of variceal bleeding. The most frequent bleeding point was the cardia and a good correlation between variceal size and bleeding was observed. There was no relationship with evidence of gastroesophageal reflux.

Acute Disease↗
PubMed1987

Influence of concomitant aspirin or prednisone on methotrexate synovial fluid concentration.

Methotrexate (MTX) is currently being used in the treatment of patients with rheumatoid arthritis. The purpose of this study was to investigate the effect of two classes of drugs, steroids and salicylates, on MTX synovial fluid concentrations. A novel canine model of monoarticular inflammation was used, in which each animal served as its own control with both inflamed and normal knees in the same animal. After the 6-week immunization process, animals in each group received either no drug (control), prednisone or aspirin (low dose and high dose) for 1 week before MTX. On the day of the study, each animal was given i.v. MTX, and serial serum and synovial fluid samples were obtained. Laboratory, histologic and clinical observations supported the presence of monoarticular inflammation. The end-of-infusion synovial MTX concentration in inflamed knees was significantly greater than in normal knees (P less than .05), but, 2 hr after the end of infusion, they were not different. The end-of-infusion ratio of synovial fluid MTX concentration to serum MTX concentration (both total and unbound) was significantly lower in the prednisone group than in the other treatment groups (P less than .05). The end-of-infusion ratio of the MTX synovial concentration in the inflamed knee compared with the normal knee at 2 hr was significantly lower in the prednisone group than in the other three treatment groups (P less than .05). These results have therapeutic implications for the use of MTX in treating rheumatoid arthritis.

Animals↗
PubMed1986

Pancreas divisum.

Explore the source record for details and available documents.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1986

Common bile duct compression by an abdominal aortic aneurysm.

A 76-year-old female was admitted to the hospital with oral bleeding. Laboratory findings were suggestive of disseminated intravascular coagulation. An endoscopic cholangiography was performed in order to rule out a biliopancreatic tumor. A symmetrical stenosis of the lower part of common bile duct was observed. This extrinsic compression was due to a calcified abdominal aortic aneurysm. CT scan confirmed the close relation between the common bile duct and the aortic aneurysm. No cholestasis was described.

Aged↗
PubMed1986

A single nighttime dose of ranitidine 300 mg versus ranitidine 150 mg twice daily in the acute treatment of duodenal ulcer: a European multicenter trial.

Six hundred and five patients with endoscopically diagnosed duodenal ulcer were randomly allocated to treatment with ranitidine 300 mg at night or ranitidine 150 mg twice daily in a prospective double-blind multicenter trial conducted in nine European countries. Endoscopy at 4 weeks showed complete ulcer healing in 246 of 301 patients (82%) treated with ranitidine 150 mg b.i.d. and 230 of 304 patients (76%) treated with ranitidine 300 mg at night. Cumulative healing rates at 8 weeks were 95 and 94% respectively. Both treatment regimens were equally effective at rapidly reducing the incidence of ulcer-related symptoms. Adverse events were few and consistent with those reported in previous studies with ranitidine 150 mg twice daily. The results of this trial indicate that a single nighttime dose of ranitidine is an effective and safe alternative to the twice daily regimen in the acute treatment of duodenal ulcer.

Adult↗
PubMed1985

Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography.

The relationship between pancreas divisum and pancreatic disease has been studied in a series of 304 patients. This congenital anatomic variant, consisting of a separate pancreatic ductal system, was diagnosed by endoscopic pancreatography and dorsal duct opacification was achieved in 97 of these patients. This anatomic variation was observed with the same frequency in cases of pancreatitis (acute and chronic) (6.9%) and in the series of patients investigated by endoscopic pancreatography taken as a whole (5.7%). Moreover, incidences of pancreatic disease in patients with and without pancreas divisum were not statistically different when compared. These results show that pancreas divisum should not be regarded as an etiologic factor in pancreatitis but should be considered as a coincidental anatomic variant encountered in nearly 10% of the population. The results obtained herein do not support the hypothesis that stenosis of the accessory papilla occurs frequently in cases of pancreas divisum. We conclude that no further therapy should be systematically proposed for patients with pancreas divisum and pancreatitis.

Adult↗
PubMed1984

Early detection of biliary pancreatitis.

Biochemical tests (serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, gammaglutamyltranspeptidase, bilirubin, and serum amylase) were performed upon admission in 84 patients with suspected (36) or proven (48) acute pancreatitis at the time of the first episode of acute abdominal pain suspected clinically as acute pancreatitis. These parameters all increased significantly more in patients with gallstone pancreatitis. Among them, the SGPT was the most discriminant test between biliary and nonbiliary pancreatitis. The positive predictive value of SGPT was 92%, when the cutoff point was chosen at twice the upper limit of normal. In patients with increased SGPT, a SGOT-SGPT ratio less than 1 is the rule (88%) for those with gallstone pancreatitis. This enzymatic determination allowed us to select more accurately the patients suitable for morphological procedures to confirm the biliary origin of the pancreatitis.

Acute Disease↗
PubMed1984

Sonographic monitoring of biliary endoprostheses.

Biliary drainage by endoprosthesis, inserted either transcutaneously or endoscopically, is as effective and better supported than percutaneous drainage, but harder to control. Forty-four patients with biliary or pancreatic carcinoma treated by endoprostheses were followed up by ultrasound. Sonography was effective in the demonstration of the drainage effectiveness and the detection of prosthetic dysfunction or eventual complications. Consequently, it may be considered a valuable method to complement the biochemical tests in the monitoring of endoprostheses.

Aged↗