[The watermelon-stomach; linear convolutions of vascular ectasias in the antrum].
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Blood Vessels↗
Biomedical subjects
M van Blankenstein
Publications and source records attributed to M van Blankenstein.
Extracorporeal shock wave treatment of common bile duct stones: experience with two different lithotriptors at a single institution.
Extracorporeal shock wave lithotripsy (ESWL) is a new treatment modality for retained common bile duct stones. Sixty-two patients (mean age 75 years, range 27-95 years) with retained common bile duct stones were treated with two different lithotriptors. One of the lithotriptors operated on the electrohydraulic principle (Dornier HM-3) (n = 13), the other on the electromagnetic principle (Siemens Lithostar) (n = 49). All HM-3 patients were treated under general anaesthesia, whereas with the Lithostar one patients was treated under general anaesthesia, 43 received analgesia and sedation and five had no analgesia at all. Patients treated with the Lithostar had more sessions (mean 1.9 versus 1.3, P less than 0.05) and needed more stock waves (mean 8611 versus 2534, P less than 0.001) than patients treated with the HM-3. Fragmentation was achieved in all patients treated with the HM-3 and in 42 (86 per cent) patients treated with the Lithostar. In this latter group ten patients underwent common bile duct exploration without complications. Eleven patients had transient haematuria after treatment with the HM-3 and two patients (one in each group) had a subcapsular haematoma of the right kidney, all without clinical sequelae. At follow-up (median: HM-3 43 months, Lithostar 18 months), none of the patients had biliary complaints. We conclude that ESWL of retained common bile duct stones in safe and effective with both lithotriptors and should be considered before surgery in the elderly or high-risk patient.
Adult↗
Disinfection of fiberscopes by thermochemical disinfection.
A new fully automated washing and disinfection machine for fiberscopes was evaluated. This apparatus, the Endoscopic Thermo Disinfector (ETD) uses a combination of heat and a brand name disinfectant containing glutaraldehyde to fulfill its purposes. The disinfectant showed effective antibacterial activity at the concentrations used in the ETD. After artificial contamination of fiberscopes with high concentrations of various bacteria the washing and disinfection process was completely effective. Contaminated debris was also effectively removed from fiberscopes and from the inside of the washing machine during this process. A number of improvements in the design of the washing machine were implemented during the test period and suggestions for further improvements will be considered. Taking into consideration the reported effects of the disinfectant used against viral pathogens, the ETD washing machine effectively cleans and disinfects flexible watertight endoscopes.
Disinfection↗
Primary bile acid diarrhoea without an ileal carrier defect: quantification of active bile acid transport across the ileal brush border membrane.
Unexplained bile acid malabsorption associated with diarrhoea that responds to cholestyramine was first described in 1973 but convincing evidence of the proposed mechanism--a defective active ileal bile acid transport--has never been substantiated. Active bile acid transport was quantified in vitro using brush border membrane vesicles prepared from terminal ileal biopsy specimens from 10 patients who fulfilled the criteria of idiopathic bile acid diarrhoea. They were recruited from 181 patients with bile acid malabsorption of various causes. Transport was quantified as in vitro Na+ dependent bile acid transport (INBAT), expressed as pmol taurocholate/mg brush border membrane protein/15 seconds, and in vitro Na+ dependent bile acid local transport capacity (INBALTC), expressed as pmol taurocholate/g ileal biopsy tissue/15 seconds. The lowest INBAT and INBALTC values in the 10 patients with idiopathic bile acid diarrhoea were well above the 10th centile values of a control group of 132 patients. Both INBAT (mean (range) 88 (30-136)) and INBALTC (158 (85-268)) values were significantly higher in the 10 patients than in the control group (INBAT: mean (range) 63 (1-244), INBALTC: mean (range) 98 (1-408)). Quantification of active ileal bile acid transport in these 10 patients with idiopathic bile acid malabsorption suggests that a genetic (carrier) defect is rare in adults.
Adult↗
Malignant biliary obstruction: percutaneous use of self-expandable stents.
A total of 83 self-expandable metallic stents were placed percutaneously in 69 patients for palliation of malignant biliary obstruction. Stent diameter was 1 cm; length, 3.5-10.5 cm. Of the 41 patients with common bile duct obstruction, 27 died 0.2-12 months (median, 3.2 months) after stent insertion. Two patients developed recurrent jaundice and cholangitis after 6 and 12 months, respectively. One patient underwent reintervention. Fourteen patients were alive without jaundice 1-8 months (median, 6.3 months) after stent placement. Of the 28 patients with hilar lesions, 13 died 0.7-7.6 months (median, 4.3 months) after stent placement. Fifteen were alive 1-15.5 months (median, 8.1 months) afterward. Recurrent jaundice and cholangitis were seen in eight of the 28 patients (28%) after 1-6 months (median, 3.6 months). The cause of malfunction of the stent(s) was tumor ingrowth in one patient, tumor overgrowth at the proximal end in five patients, and overgrowth at the distal end in two patients. Reintervention was performed in five patients (18%). Stent-related complications were seen in four patients.
Adult↗
Extracorporeal shock wave lithotripsy of pancreatic duct stones.
Chronic calcifying pancreatitis presents a major clinical problem, often requiring extensive surgery. Extracorporeal shock wave lithotripsy (ESWL) offers a new therapeutic option. We applied ESWL after endoscopic sphincterotomy of the pancreatic orifice in eight patients with impacted pancreatic duct stones. An electromagnetic lithotriptor (Siemens Lithostar, Erlangen, FRG) was used. Patients were treated in prone position under fluoroscopic control. A mean of 6,813 shock waves (range 1,500-10,000) was delivered in one or two sessions. Disintegration of stones was achieved in 6/8 patients, initial relief of pain in 7/8 patients, and total clearance of the pancreatic duct in 3/8 patients. One patient had an exacerbation of her pancreatitis one day after ESWL, which resolved rapidly with medical treatment. No other complications were observed. Four of five patients with fragmented stones had no abdominal complaints at follow-up (mean 17 months, range 3-27). Three patients in whom ESWL was not completely successful (two without and one with partial fragmentation) underwent an operation according to Puestow. Two of them still have abdominal complaints after surgery. From these data, we conclude that ESWL of pancreatic duct stones is a promising new alternative for surgery, when endoscopic stone extraction fails.
Adult↗
Esophageal verrucous carcinoma: histologically a low-grade malignancy but clinically a fatal disease.
A 76-year-old woman had a verrucous carcinoma of the esophagus with a fistula of the left main bronchus. We discuss this case together with those of eleven other patients with verrucous carcinoma of the esophagus reported previously. Differentiation between this tumor and squamous cell papilloma is often difficult. The central cores of fibrous tissue in verrucous carcinoma are heavily infiltrated with inflammatory cells, which accounts for the stenosis often found. The mortality in verrucous carcinoma of the esophagus is 67% even though histologically it is a low-grade malignancy.
Adult↗
The selenium-75-homocholic acid taurine test reevaluated: combined measurement of fecal selenium-75 activity and 3 alpha-hydroxy bile acids in 211 patients.
The recommended reference values for the selenium-75-homocholic acid taurine (75SeHCAT) test, used in the analysis of chronic diarrhea, were evaluated in 211 patients by comparing simultaneous measurements of 3 alpha-hydroxy bile acids and 75Se activity in daily collected stools. An initial evaluation in 11 patients showed that the fecal collection method, which allows inspection and additional analysis of stools, was equivalent to the abdominal retention method. Selenium-75-HCAT whole-body retention half-life (WBR50) was greater than 2.8 days in less than 10% of the patients with bile acid malabsorption and less than 1.7 days in less than 10% of the normals. We recommend that a 75SeHCAT WBR50 less than 1.7 days is abnormal, a WBR50 greater than 2.8 days is normal, and a WBR50 in the range 1.7-2.8 days is equivocal, which was the case in 48% (94/195) of the patients in this study.
Bile Acids and Salts↗
[Biliary ascariasis as complication following cholecystectomy for cholelithiasis].
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Ascariasis↗
['Globus'; real or virtual?].
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Deglutition Disorders↗
[Biliary ascariasis as complication after cholecystectomy for cholelithiasis].
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Ascariasis↗
Effects of highly selective vagotomy on gastric myoelectrical activity. An electrogastrographic study.
Changes in gastric myoelectrical activity following highly selective vagotomy were studied in 12 patients by means of electrogastrography (EGG) using cutaneous electrodes. Measurements were made before, 10 days after, and six months after operation. Eight patients undergoing cholecystectomy served as controls. Preoperatively all controls and patients had normal recordings. In the cholecystectomized patients no significant changes were found postoperatively. Ten days after highly selective vagotomy the normal initial postprandial dip in gastric ECA frequency and the subsequent increase in frequency and power were not seen. Tachygastrias were observed in three patients. Six months after operation the normal frequency and power responses to a test meal had returned, but both the fasting and postprandial ECA frequencies were raised significantly. It is concluded that highly selective vagotomy is associated with abnormalities in myoelectrical activity, in particular in the postprandial state, most of which are reversible with time.
Adult↗
Na+-dependent bile acid transport in the ileum: the balance between diarrhea and constipation.
Ileal Na+-dependent bile acid transport was quantified in vitro as the uptake of 3H-taurocholate into brush-border membrane vesicles. Vesicles were prepared from ileal biopsies of 158 patients placed in 10 diagnostic categories. Active bile acid transport (expressed as picomoles taurocholate uptake per milligram brush-border membrane protein per 15 s, median and interquartile ranges indicated) did not differ significantly in 6 categories: irritable bowel syndrome (71, 35-97; n = 21), colon polyps (42, 30-89; n = 29), colitis (62, 33-91; n = 31), postvagotomy or postcholecystectomy (69, 37-97; n = 11), diarrhea without increased bile acid loss (58, 48-85; n = 12), and lack of gastrointestinal pathology (74, 45-103; n = 22). A decreased active bile acid transport was found in 3 categories: ileal disease (4, 1-36; n = 11), partial ileal resection (5, 1-35; n = 5), and constipation (41, 22-50; n = 8). Bile acid transport was increased in patients with bile acid-losing diarrhea with endoscopically and histologically normal ilea (111, 94-135; n = 8). These findings indicate that a low fecal bile acid loss, presumed to be present in constipated patients, is associated with a low Na+-dependent ileal bile acid transport and a high bile acid loss is associated with a high active bile acid transport. Ileal bile acid transport might be regulated by the availability of bile acids to the ileal enterocytes.
Bile Acids and Salts↗
The role of radiotherapy in the treatment of bile duct carcinoma.
Forty-two patients with irresectable bile duct carcinoma (n = 31) or with microscopic evidence of tumor rest after aggressive surgery for bile duct carcinoma (n = 11) were given radiotherapy consisting intentionally of external-beam therapy and intraluminal 192Iridium (192Ir) wire application(s) following bile drainage procedures. The treatment was well tolerated; complications were mainly infectious and related to the success of the drainage. A median survival of 10 months was achieved for the group as a whole. Patients treated following microscopically incomplete resection survived longer than patients with an irresectable tumor (15 vs 8 months median survival, p = 0.06). Gross lymph node involvement also proved to be a prognostic factor.
Adenoma, Bile Duct↗
The management of malignant esophago-respiratory fistulas with a cuffed prosthesis.
Peroral intubation with a standard prosthesis fails to occlude inoperable malignant esophago-respiratory fistulas located above the narrowed segment, or when there is little or no stricture at all. Ten patients with malignant esophago-respiratory fistulas were intubated perorally with a prosthesis surrounded by a foam ruber cuff contained in a silicone sheath, in which a vacuum can be created. The type of fistula was esophago-bronchial in 6 patients, esophago-tracheal in 3 patients, and gastro-tracheal in 1 patient. The fistula was located above the stricture in 8 patients and in a malignancy without a stricture in 2 patients. The diameter of the opening of the fistula ranged between 1 and 3 cm. Complications with the cuffed tube were recurrent leakage after a period of 30 days in situ in 1 patient, and compression of the trachea immediately after intubation in 1 patient. Adequate palliation, that is, no symptoms related to the fistula, good transit of food and discharge from hospital within a few days was achieved in 9 patients for an average period of 37.2 days (10-84 days). The cuffed esophageal prosthesis can improve the quality of life in patients with malignant esophago-respiratory fistulas that do not respond to conventional intubation.
Aged↗
Malignant common bile duct obstruction: factors influencing the success rate of endoscopic drainage.
The problems encountered in draining the bile ducts endoscopically in 148 patients with malignant obstruction of the mid or distal common bile duct and/or the papilla were assessed. Endoscopically visible extrinsic invasion of the papilla by a malignancy in the pancreatic head, with or without duodenal stenosis, appeared to be the major reason for the failure to insert a stent. The larger a tumor in the pancreatic head the greater the chance of invasion of the papillary region. This appeared to be evident for tumors restricted to the non-uncinate region of the pancreatic head. We would recommend primary percutaneous biliary drainage or surgery when the size of a proven malignancy restricted to the non-uncinate region of the pancreatic head is 5 cm or more, or when diagnostic duodenoscopy reveals extrinsic invasion of the papilla of Vater, or severe duodenal involvement with stenosis.
Adenoma, Bile Duct↗
Effect of pravastatin on biliary lipid composition and bile acid synthesis in familial hypercholesterolaemia.
Nine patients with heterozygous familial hypercholesterolaemia were treated for eight weeks with either 40 mg pravastatin or placebo under double blind conditions. Six patients received pravastatin, a competitive inhibitor of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase. Treatment with pravastatin resulted in a significant decrease in plasma cholesterol caused by a decrease in low density lipoprotein cholesterol (LDL-c) of 30% (p less than 0.005). We determined the effect of this medication on the lithogenicity of bile. Cholesterol saturation index of fasting gall bladder bile decreased with 23% (p less than 0.01) from 1.06 to 0.75 during treatment with pravastatin. A reduction of 24% (p less than 0.01) in molar percentage of biliary cholesterol was seen. After treatment the total bile acid excretion in faeces and the molar percentage of biliary bile acids were not significantly changed, suggesting that pravastatin does not influence bile acid biosynthesis to a significant extent. These findings indicate that treatment with pravastatin can decrease the incidence and complications of cholesterol gall stones.
Adult↗
[Analysis of the surgical treatment of pancreas head and peri-ampullary carcinoma in 236 patients].
Between 1978 and 1987, 236 patients were admitted for cancer in the pancreas or periampullary region. In 93 patients a resection of curative intent was performed, while 88 patients underwent a palliative procedure and 55 patients no operation. The operative mortality was 9%. In the complete group of patients, age above 70 years and preoperative jaundice were of prognostic significance. A tumour size greater than 3.5 cm after resection implies a better prognosis than tumours less than 3.5 cm. The 1-, 3- and 5-year survival rates of the resected patients with pancreatic head cancer were 59%, 12% and 8% respectively, those of patients with periampullary cancer 90%, 49% and 30% respectively. After a palliative procedure or only a laparotomy survival was significantly lower (p less than 0.001), with 1-year survival of 16% and 2-year survival of 4%. After resection of curative intent for cancer of the head of the pancreas 21 cases still had microscopical remnants of tumour (T3, N1b). Survival of these patients was not significantly different from that of patients with a curative resection. Surgical resection for cancer of the head of the pancreas has to be considered as a mainly palliative treatment, but given low operative mortality (less than 10%) it is still the treatment of choice to gain longer survival and in some cases definitive cure.
Adult↗