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Biomedical subjects

M Staritz

Publications and source records attributed to M Staritz.

At least 91 records · Page 5Linked to original sources
PubMed1986

Effect of modern analgesic drugs (tramadol, pentazocine, and buprenorphine) on the bile duct sphincter in man.

Modern narcotic analgesic drugs, such as tramadol, pentazocine, and buprenorphine share similarities of molecular structure with morphine which is widely believed to cause spasm of the bile duct sphincter and so impede bile flow. This study assessed the effects of intravenously administered analgesics on bile duct sphincter motor activity measured by ERCP manometry. Ten minutes after pentazocine injection the duration of contractions and baseline pressure of the bile duct sphincter rose from 6.2 +/- 0.2 to 8.2 +/- 0.27 s and from 5.1 +/- 0.6 to 8.8 +/- 0.4 mmHg respectively. Tramadol, buprenorphine and saline showed no such effect. These data indicated that the effects of such drugs on bile duct sphincter function can be safely assessed by ERCP manometry and that pentazocine adversely affects the bile duct sphincter, whilst tramadol and buprenorphine do not. We consider therefore that pentazocine is not the premedication of first choice for endoscopic procedures involving the sphincter of Oddi and should also be avoided in patients with pancreatic and biliary disorders.

Adult↗
PubMed1986

Is the bile duct diameter a reliable parameter to diagnose extrahepatic cholestasis? Relationship between bile duct diameter and bile duct pressure.

The common bile duct (CBD) pressure was determined in 57 patients before endoscopic retrograde cholangiography (ERC) and related to the diameter of the CBD and the common hepatic duct (CHD). We found that despite a weak overall positive correlation in the individual patient, CBD or CHD diameters do not correlate with CBD pressure. In patients without extrahepatic cholestasis and normal CBD pressure, both CBD and CHD diameters were measured in a wide range between 5 and 32 mm. Extrahepatic cholestasis due to distal CBD obstruction is reflected by a high CBD pressure, but cannot be identified reliably by measuring the CBD diameter which is found within the range of patients not obstructed. In cholecystectomized patients, CBD and CHD are significantly (p less than 0.005) wider than in non-cholecystectomized patients (8.8 +/- 1.0 vs. 13.3 +/- 1.2 and 9.2 +/- 0.9 vs. 14.2 +/- 1.2 mm, respectively). The CBD pressure, however, is nearly identical in both groups. It is concluded that the assessment of CBD and CHD diameter is not a reliable parameter for the diagnosis of extrahepatic cholestasis which--in certain cases--could be proved by endoscopic retrograde manometry.

Cholangiography↗
PubMed1986

Endoscopic measurements of intravascular pressure and flow in blood vessels of gastrointestinal tract.

Endoscopic measurements of flow and pressure in blood vessels of the gastrointestinal tract are very young techniques which have been described in the last three years. Laser doppler flowmetry provides measurement of blood flow in humans; the results are thought to reflect mucosal blood flow, at least in the stomach. Provided that the first encouraging results can be confirmed by further studies, the technique should open up new possibilities for endoscopic research. Endoscopic application of the doppler ultrasonic probe can be used to detect blood flow in the paravaterian region and in oesophageal varices. The clinical value of the detection of small arteries at the site of endoscopic papillotomy may be useful in the prevention of post-papillotomy bleeding. Since this complication rarely occurs, the clinical value of the doppler is likely to be limited in this field. Investigation of the flow pattern in oesophageal varices is a very interesting subject. The results, however, are not easy to understand. Further studies and the comparison of the pressure profile with the flow profile of the varix should provide better insight into portal hypertension pathophysiology. Due to its clinical importance, further interesting studies and results should ensue from this field. To date, most studies have involved measuring the pressure in oesophageal varices. Both the application of the pneumatic pressure gauge and the puncture technique are easy to perform. The simultaneous application of the two techniques (Staritz and Gertsch, 1985) revealed the advantages and disadvantages of the procedures. The invasive puncture provides exact and reproducible measurement of the IOVP in smaller varices (grade II) and the tracings are easy to read, whereas the pneumatic pressure gauge can only be attached to large varices (grade III and IV), and artefacts caused by respiration, patient's movements, oesophageal peristalsis and deviation of the pressure gauge from the variceal column affect the practicability of the procedure. The results simultaneously obtained by the two methods were only in accordance in some of the patients. The present form of the pressure gauge therefore needs improvement. Further investigations will elucidate whether the exact, reproducible, but invasive puncture technique can be replaced by less invasive pressure devices. Finally it should be pointed out that all endoscopic methods suffer from the common flaw that it is not yet clarified whether or not endoscopy affects flow and/or pressure in gastrointestinal vessels. Therefore, further studies should be carried out to establish the reliability of these methods.

Ampulla of Vater↗
PubMed1985

Endoscopic removal of common bile duct stones through the intact papilla after medical sphincter dilation.

Recently, glyceryl trinitrate was shown to effectively dilate the smooth muscle of the sphincter of Oddi. This information was applied to endoscopic therapy of bile duct stones. In 21 patients a total of 32 common bile duct stones, 6-12 mm (means = 8.7 mm) in diameter, were removed through the intact sphincter after its medical dilation by administration of 1.2-3.6 mg glyceryl trinitrate. Thirty of 32 stones could be extracted without difficulty. The remaining two concrements had to be crushed by endoscopic mechanical lithotripsy before removal. No complications were observed during or after the procedure. Follow-up manometric examinations showed the papillary function to be well preserved. We therefore consider this new, safe, and easy method to be the treatment of choice for the removal of small- and medium-sized bile duct stones.

Ampulla of Vater↗
PubMed1985

ERCP using a special catheter with external steering. A reliable aid in typical ERCP problems.

ERCP is the most sensitive procedure for opacification of the bile and pancreatic ducts. The procedure fails, however, in up to 60% of Billroth II resected patients, and in 5% of nongastrectomized patients, often owing to problems of papillary cannulation with the conventional ERC-catheter, or insufficient control in the bile duct. Therefore, we attempted to perform ERCP with a catheter provided with external steering, which can be introduced through the channel of any commercially available endoscope. This catheter permitted successful ERCP in 11 patients in whom conventional ERCP technique had failed. The endoscopic procedure with the catheter described was simple and reduced papillary cannulation problems in patients with juxtapapillary diverticulum and in those with Billroth II resection, and it permitted selective opacification of intrahepatic bile ducts or the cystic duct.

Catheterization↗
PubMed1985

Effect of glyceryl trinitrate on the sphincter of Oddi motility and baseline pressure.

It is widely accepted that glyceryl trinitrate (GTN) effectively dilates the smooth muscles of blood vessels. A similar effect has been postulated on the smooth muscles in the gastrointestinal tract. In this study the motility of the sphincter of Oddi and the common bile duct pressure as determined by endoscopic manometry was investigated in nine patients before and after sublingual application of 1.2 mg GTN (nitro group). Eight untreated patients served as controls. Three minutes after application of GTN the papillary contraction amplitude decreased from 69.3 +/- 4.3 mmHg to 36.8 +/- 5.1 mmHg (p less than 0.005) and the papillary baseline pressure fell from 8.9 +/- 0.6 mmHg to 2.9 +/- 0.2 mmHg (p less than 0.005) respectively. The contraction frequency in the nitro group and all motility parameters in the control group remained unchanged. These results indicate that GTN does not influence the sphincter of Oddi motility, but it relaxes very effectively the sphincter of Oddi muscle. Thus, GTN should be taken into account for the treatment of biliary colic. In our endoscopic unit GTN proved to be useful as premedication for endoscopic examinations, particularly for the removal of small and medium size common bile duct stones through the intact papilla.

Adolescent↗
PubMed1985

Intravascular oesophageal variceal pressure (IOVP) assessed by endoscopic fine needle puncture under basal conditions, Valsalva's manoeuvre and after glyceryltrinitrate application.

A simple and safe procedure providing sensitive and reproducible direct measurement of intravascular oesophageal variceal pressure (IOVP) during routine oesophagoscopy is described. The method requires only commercially available equipment. First results were obtained in 16 patients with oesophageal varices caused by liver cirrhosis (Child's A) can be summarised as follows: intravascular oesophageal variceal pressure was nearly identical in different varices of the single patient. Varices grade III exhibited a significantly higher intravascular oesophageal variceal pressure than varices grade II (22.7 +/- 2.5 vs 15.7 +/- 0.6 mmHg, p less than 0.05). After Valsalva's manoeuvre there was a remarkable increase in intravascular oesophageal variceal pressure by 13.6 +/- 1.0 mmHg irrespective of the variceal size. The high intravascular oesophageal variceal pressure values observed in grade III varices during the rise of the intraabdominal pressure may indicate an important risk factor for variceal haemorrhage. Glyceryltrinitrate (1.2 mg sprayed onto the tongues of 14 patients) very effectively lowered the intravascular oesophageal variceal pressure from 22.8 +/- 2.0 to 12.0 +/- 0.4 mmHg in grade III varices, and from 16.3 +/- 0.4 to 10.0 +/- 0.4 mmHg in grade II varices (p less than 0.005 in both groups). We conclude that this method provides a suitable tool to study the effect of drugs with presumed influence on the oesophageal variceal pressure and that the impressive effect of glyceryltrinitrate in lowering intravascular oesophageal variceal pressure warrants further study on the effect of longer acting nitrates on intravascular oesophageal variceal pressure, and the rebleeding rate after oesophageal variceal haemorrhage.

Blood Pressure↗
PubMed1985

Effect of the artificially elevated common bile duct pressure on the motor activity and function of the papilla of Vater. A study by endoscopic manometry.

In 10 patients without disease of the pancreatico-biliary system, the common bile duct pressure was artificially elevated by endoscopic retrograde feeding with saline under manometric control. The motor activity of the papilla of Vater was recorded by endoscopic manometry using the hydraulic capillary perfusion system according to Arndorfer. Compared to the baseline motility, a mild pressure elevation (from 9.75 +/- 1.8 to 13.5 +/- 0.26 mm Hg) had no effect. After the following strong pressure elevation (to 32 +/- 0.9 mm Hg), however, the papillary residual pressure and the wave duration of the papillary contractions increased significantly (p less than 0.001) from 5.5 +/- 0.5 s and 6.3 +/- 0.16 mm Hg to 10.7 +/- 0.75 s and 8.6 +/- 0.64 mm Hg, whereas the papillary contraction frequency and amplitude were not affected. These data indicate several clinically important speculations.

Adult↗
PubMed1985

Cellular cytotoxicity against autologous hepatocytes in chronic hepatitis B--its relationship to the HBeAg/anti-HBe status.

Cellular cytotoxicity of peripheral blood lymphocytes against autologous hepatocytes was studied in 9 patients with HBeAg positive and 8 patients with anti-HBe positive chronic hepatitis B. In the HBeAg positive group a greatly increased cytotoxicity of 41 +/- 7% (mean +/- SEM) was found, in contrast the moderately increased cytotoxicity in anti-HBe positive cases of 15 +/- 5% was clearly different (p = 0.005). The different cytotoxicity values could not be explained on the basis of the histological classification, but seemed to correlate at least to some degree to the aminotransferase levels. The cytotoxic activity resided in both T cell and non-T cell enriched lymphocyte compartments. Our findings may provide an explanation for the poor prognosis of HBeAg positive patients with chronic hepatitis B in contrast to their anti-HBe positive counterparts.

Alanine Transaminase↗
PubMed1985

Age and sex dependency of bile duct diameter and bile duct pressure--an ERC manometry study.

Using ERC-manometry diameters of the common bile duct (CBD) the common hepatic duct (CHD) as well as CBD pressure before and after opacification were determined in 35 non-cholecystectomized patients without extrahepatic cholestasis. We found a significant rise of both CBD and CHD diameters as well as CBD pressure recorded before the injection of contrast medium with increasing age. (p less than 0.005, less than 0.001 and less than 0.05 respectively). Following the opacification CBD pressure became elevated. Again this increase tended to be more pronounced in older patients although this association was lacking statistical significance. In the presence of comparable age female patients (n = 16) exhibited higher CBD and CHD diameters (n.s.) as well as CBD pressure values (p less than 0.05) than male patients (n = 19). We conclude that in the absence of extrahepatic cholestasis bile duct diameter as well as bile duct pressure rise significantly with increasing age. Furthermore women tend to have higher diameters and pressure values than men.

Adult↗
PubMed1984

[Polycythemia in kidney cysts. A report on an unusual case].

A 43-year-old woman with a solitary renal cyst developed polycythaemia. 21 well documented cases of this type have been previously published. In the majority of them a causal connection could be assumed between the renal cyst and polycythaemia: in 13 of the 15 cases (as in the reported one), the polycythaemia disappeared after surgical removal of the cyst. Measurement of serum erythropoietin can help in the differential diagnosis, but exclusion of polycythaemia vera may be difficult in the individual case.

Adult↗