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Biomedical subjects

N Soehendra

Publications and source records attributed to N Soehendra.

At least 19 recordsLinked to original sources
PubMed1992

Enlarged lymph nodes: malignant or not?

Prospective controlled data of lymph node evaluation by endoscopic ultrasound in esophageal, gastric and pancreatic cancer is presented. Lymph node pattern, changes of boundaries and echogenicity were considered. Preoperative findings of endoscopic ultrasound were classified according to TNM staging. Only those cases with subsequent histologic examination of the resected specimen were entered into the study. Sensitivity of endoscopic ultrasonography (EUS) was 90% for esophageal and 87% for gastric cancer. The specificity was 72% and 88%, respectively. In spite of the overall satisfactory results of EUS in evaluation of lymph nodes, further improvement in detection and differentiation of benign and malignant nodes is required.

Endoscopy, Digestive System↗
PubMed1991

Endoscopic sclerotherapy--personal experience.

Over the last 12 years, treatment of bleeding esophageal and gastric varices has improved considerably. By the use of new techniques and with increased experience the results of endoscopic sclerotherapy have been optimized. Acute variceal bleeding, esophageal or gastric, can now be reliably and definitively stopped using the tissue adhesive Histoacryl Blau. This is also applicable to all patients irrespective of their liver status at presentation. As expected, the mortality of acute variceal bleeders has decreased considerably, no death from bleeding occurring in the last 5 years. This has obviated the need for emergency surgery, balloon tamponade or vasopressin infusion. Using an aggressive sclerotherapy technique in the bleeding-free interval, varices of all grades can now be effectively eliminated within an average of 3 sessions covering 3-4 weeks. With the intra- cum peri-variceal injection technique not only are the visible veins eradicated, but also fibrosis of the inner esophageal wall is achieved at the same time. If careful attention is paid to certain details of the technique and instruments, and with close follow-up, patients of portal hypertension can now live well in terms of liver function, without the danger of further variceal bleeding.

Endoscopy, Gastrointestinal↗
PubMed1990

Endoscopic treatment of a pancreatic abscess originating from biliary pancreatitis.

We present a case report of a patient with two large pancreatic abscesses and an associated colonic fistula originating from acute gallstone pancreatitis, which we treated endoscopically. The common bile duct stones were extracted after a papillotomy. The abscess in the pancreatic head was drained into the duodenum and the one in the pancreatic tail irrigated through a nasopancreatic catheter using normal saline mixed with gentamycin. The colonic fistula was finally obliterated using a two-component fibrin glue.

Abscess↗
PubMed1990

Immunochemical characterization and quantitative distribution of pancreatic stone protein in sera and pancreatic secretions in pancreatic disorders.

A fluorometric immunoassay has been established to quantitate pancreatic stone protein providing a sensitivity for concentrations from 0.015 to 0.5 micrograms/mL. When concentrations of pancreatic stone protein were determined from pancreatic secretions obtained either from patients suffering from chronic pancreatitis (n = 31) [including the calcifying forms (n = 10)], pancreatic cancer (n = 22), or nonpancreatic diseases (n = 17), no significant differences were found. In contrast, increased concentrations were found in serum samples from patients with chronic (39/66) and acute pancreatitis (16/20) compared with control patients. The differences between these diagnostic groups and controls were highly significant (P less than 0.0001) and independent of pancreatic enzyme activity. Immunochemical analyses of serum pancreatic stone protein showed an isoelectric point (pH 9) similar to that reported for the pancreatic thread protein. With respect to recent communications, these data do not support the etiopathogenic role postulated for pancreatic stone protein in chronic pancreatitis and chronic calcifying pancreatitis by other investigators.

Adult↗
PubMed1990

Endoluminal ultrasound for the diagnosis and staging of pancreatic cancer.

For pancreatic cancer, endosonography is at present the most accurate method of imaging, especially for detecting small lesions and assessing the extent of locoregional tumour spread. Although the overall accuracy of tumour detection is nearly 100%, differentiation between cancer and pseudotumours of inflammatory origin may sometimes present a problem. Clinical history, symptoms and other imaging techniques, particularly ERCP, should therefore always be considered. On the other hand, endosonography is indicated when the other imaging techniques are negative or doubtful in the presence of a high index of clinical suspicion. In cases with proven malignant tumours, it should be performed for proper staging. The overall accuracy of staging the primary tumour is 80-90%, whereas for detecting lymph nodes it is around 75%. In contrast to angiography, endosonography gives more detailed information of major vessel involvement, an important factor in deciding whether the tumour is resectable. Endosonography is, however, not suitable for the detection of distant metastasis due to the limited penetration of ultrasound. The newly developed echoduodenoscopes, equipped with a working channel and an elevator, provide the possibility for improved accuracy of biopsy under endosonographic guidance, and under clinical evaluation. This should further improve the differentiation between pancreatic cancer and inflammatory pseudotumours, which continues to be a significant clinical problem. So far no procedure-related complications of endosonography have been reported. An adequate experience in conventional ultrasound and endoscopy is essential, however, in order to achieve reliable results.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

ESWL and gallstone dissolution with MTBE via a naso-vesicular catheter.

Endoscopic placement of a naso-vesicular catheter was successful in 90% (45/50) of patients with cholecystolithiasis. The first 7 patients were treated by MTBE dissolution alone. Dissolution was discontinued after a maximum of 14 days, as only two patients were rendered stone free. In one patient, 3 tiny pigment stones were sucked out through the catheter, and in another inoperable patient a pigtail endoprosthesis was finally inserted into the gallbladder. In the remaining 36 patients, combined ESWL and MTBE dissolution therapy was carried out. Treatment was broken off by one patient after one week, and interrupted in another due to catheter dislodgement. After an average of 10 days with 1-9 ESWL sessions (average: 3) complete stone clearance was achieved in 60% (20/34) of patients. Fourteen of the patients who completed treatment, and the one with catheter dislodgement still have sludge in the gallbladder, which is being treated with oral bile acids. The procedure-related complication rate was 10% (3 pancreatitis, 1 cystic duct perforation and 1 guidewire impaction). The mortality rate was zero. There was no evident complication due to either ESWL or MTBE dissolution.

Catheterization↗
PubMed1990

A new technique for replacing an obstructed biliary endoprosthesis.

We report on a new method of stent exchange using a threaded device that enables removal of the clogged stent while simultaneously maintaining the original pathway without withdrawing the endoscope. With this method stent replacement has become more reliable, safer, simpler and quicker. This technique is also suitable for removal of stents dislodged inside the duct.

Cholestasis↗
PubMed1990

[Technical variants and problems in endoscopic tube implantation].

Compared to other endoscopic procedures, implantation of an esophageal prosthesis is a relatively invasive treatment modality. It is mainly indicated as a symptomatic therapy in patients with unresectable tumours. The indication should therefore be clearly established. Since the results of surgery and radiotherapy have improved, an objective selection of the treatment modality is only possible in an interdisciplinary set-up. Any palliative therapy is expected not only to be less risky but should be immediately effective in relieving the patients symptoms and thus improve the quality of life. Endoscopic tube implantation fulfils this requirement regarding relief of dysphagia compared with other palliative methods eg: laser/BICAP. Re-establishing a lumen for oral feeding with photo or electrocoagulation in very advanced tumours is a long and labourious path. For such cases and for fistulae, implantation of a tube is the treatment of choice.

Esophageal Neoplasms↗
PubMed1989

[Extracorporeal shockwave lithotripsy in chronic pancreatitis].

Extracorporeal shock wave lithotripsy was performed on eight patients (six men, two women; mean age 46.3 years, range 36-58) with predominantly stone-induced obstructive pancreatitis. Stones in the pancreatic duct were smashed in one session to such an extent that the fragments were eliminated spontaneously via the ostium which had previously been split endoscopically. Repeat lithotripsy to achieve complete removal was necessary in only two patients. In one there were multiple concrements along the entire length of the main pancreatic duct; the other had a cherry-sized stone near the bifurcation of the accessory pancreatic duct. There were no serious complications. After successful removal of the stones all patients were free of pain which before had required strong analgesics to control. Six patients remained pain-free during a follow-up period of two eight months. Pain again occurred in the other two, but it was less frequent and milder.

Adult↗
PubMed1989

Occluded pancreatic endoprostheses--analysis of the clogging material.

One of the most common late complications of transpapillary pancreatic endoprostheses is clogging of the endoprosthesis lumen. In this study we analysed the morphology and the biochemical nature of the contents of 10 clogged pancreatic endoprostheses. At the optical level the sludge presented as an organic matrix with embedded small quantities of CaCO3 crystals (and in one case CaCO3 microcalculi). Electron microscopy showed the presence of bacterial ghosts and protein threads. The characteristic pattern of proteolysed pancreatic proteins was obtained when the organic matrix was analysed by SDS-Page. The presence of trypsinogen, amylase and one of the molecular secretory forms of Pancreatic Stone Protein (PSP) was confirmed by Western-blotting. PSP was also found in association with CaCO3 crystals by immunolocalization. These results suggest that endoprosthesis clogging is due to the precipitation of whole pancreatic juice protein, probably triggered by uncontrolled proenzyme activation.

Amylases↗