Search PubMed⌕ Search

Biomedical subjects

N Soehendra

Publications and source records attributed to N Soehendra.

At least 127 records · Page 7Linked to original sources
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↗
PubMed1989

New modalities for treating chronic pancreatitis.

Over the last few years, a new method, neither medical nor surgical, has been developed for treating often difficult-to-treat chronic pancreatitis. In the case of obstructive pancreatitis, endoscopy permits both drainage and calculus extraction. Even encrusted concrements and calcifications can be removed from the pancreatic duct with the aid of extracorporeal shockwave lithotripsy. The first aim is to relieve pain by restoring a free flow of secretion. Perhaps the use of endoscopic treatment in the early stages will break the vicious circle of chronic inflammation and ultimate gland destruction.

Adult↗
PubMed1989

[Contribution of endosonography to preoperative staging in esophageal and stomach cancer].

A total number of 113 patients with gastroesophageal cancer (47 esophageal cancer, 66 gastric cancer) were examined by endoscopic ultrasonography (EUS). The depth of tumor infiltration in the wall, involvement of lymph nodes and spread to adjacent organs were the features particularly stressed on. 61 patients (46 with gastric cancer, 15 with esophageal cancer) underwent radical resection thus enabling a comparative study with the histological findings. The accuracy rate of EUS in determining the depth of infiltration was 85% in esophageal cancers and 77% in gastric cancers. Regarding involvement of lymph nodes, EUS was accurate in 80% of esophageal cancers and in 87% of gastric cancers, whereas CT scan was accurate in 47% and 43% respectively. For detecting spread to adjacent organs EUS was also more accurate than CT scan.

Adenocarcinoma↗
PubMed1989

[10 years' experience with endoscopic sclerotherapy of esophagogastric varices].

We report on our 10 years' experience in endoscopic sclerotherapy. A total of 1054 patients (90% of them with liver cirrhosis) were treated. During the first seven years (1978-1985) the hospital mortality of the bleeders was 31.5%. During the last three years after the introduction of tissue adhesive the mortality rate has falling to 14.5%. The rate of patients with late recurrent hemorrhages sank from 16.6 to 7.8%. This improvement of the results is in our opinion due to the more sufficient control of bleeding and treatment of fundic varices. The sclerotherapy in the interval has an overall hospital mortality of 5-6% (for all patients regardless the Child-classification). Perforations occurred in less than 1% and stenoses requiring bougienage in 2-3%. The cumulative survival curve shows that after 10 years about 40% of the patients are still alive.

Adolescent↗
PubMed1989

[Bilio-duodenal jejunum interposition as a technical alternative to Roux-Y reconstruction following reconstruction of cancer of the fork of the hepatic duct].

The inability to predict preoperatively whether resection will result in tumorfree or at least tumorinfiltrated margins, represents one essential problem in surgical treatment of central bile duct carcinoma. In a certain number of cases the operation ends with a tumorinfiltrated biliodigestive anastomosis usually performed in a Roux-en-Y-technique. In those cases early tumor recurrence is predictable, but any follow-up and treatment by endoscopic methods (laser resection, pigtail drainage) are inhibited by the long jejunal limb of the Roux-en-Y-reconstruction. Therefore we changed our operative procedure in patients with central bile duct carcinomas performing the reconstruction of intestinal bile drainage by a cholangio-duodenal interposition of a 25 cm jejunal segment. This technique now allows endoscopic reintervention in cases of recurrent tumors or benign strictures of the anastomosis which is demonstrated.

Anastomosis, Roux-en-Y↗
PubMed1988

[Prognostic parameters in liver cirrhosis, varicose bleeding and sclerosing therapy. Prospective comparison of a prognostic system with the Child classification obtained by discriminant analysis].

Prospective prognosis systems for predicting half-year death-rate after bleeding from oesophageal varices and sclerotherapy were tested on 129 patients. The receiver-operating-characteristic curves of three discriminant scores were compared with the Child-Pugh classification. It was found that the latter is still the best for prognosticating the course of the disease. A simplified discriminant score which contains as its only factors bilirubin and the Quick value does, however, give nearly as good information.

Adolescent↗