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P Bertschinger

Publications and source records attributed to P Bertschinger.

30 records · Page 2Linked to original sources
PubMed1994

[Dilatation of the common bile duct: what does endoscopic sonography contribute?].

In a prospective study 20 patients (14 women, 6 men; mean age 62 [31-81] years) with extrahepatic obstructive jaundice (n = 15) or common bile duct dilatation (CBD) without cholestasis (n = 5) were investigated by endoscopic ultrasound (EUS). All these patients underwent negative transabdominal ultrasonography (US) (n = 20) and computed tomography (CT) (n = 16). Inclusion criterion was a dilatation of the CBD of > 7 mm or > 10 mm in patients with previous cholecystectomy. The definitive diagnosis of a tumor (n = 8), choledocholithiasis (n = 7), stone migration (n = 1), choledochocele (n = 2) or slight dilatation of the CBD without obstruction (n = 2) was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) (n = 13), percutaneous transhepatic cholangiography (PTC) (n = 2), intraoperative cholangiography (n = 1) and follow up (n = 4; mean 21 [3-36] mo.). Dilatation of the CBD could be demonstrated in all cases by EUS. Common bile duct stones (2-15 mm) were demonstrated by EUS in every case. CBD dilatation without underlying obstruction was correctly identified by EUS in all patients and confirmed by further clinical and laboratory findings as well as EUS and ERCP (n = 1). EUS correctly described the localization of a malignant obstruction (n = 8) as confirmed by ERCP/PTC. All tumors (pancreatic head carcinoma n = 3, periampullary tumor (n = 5) could be visualized by EUS. The diagnosis was confirmed by surgery (n = 5) or ultrasound guided fine needle puncture (FNP) after a bile duct prosthesis had been placed (n = 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging.

PURPOSE: To compare the value of endosonography (endoscopic ultrasound [US]), dynamic computed tomography (CT), and magnetic resonance (MR) imaging in the evaluation of pancreatic tumors. MATERIALS AND METHODS: Forty-nine consecutive patients with clinical suspicion of pancreatic tumor underwent endoscopic US (n = 49), CT (n = 46), and MR imaging (n = 25). The final diagnosis of a malignant (n = 22), benign (n = 2), or inflammatory (n = 9) tumor, or no (n = 16) tumor was made at surgery (n = 28) and/or a combination of biopsy (n = 9) and 9-24-month follow-up (n = 12). RESULTS: The sensitivity was 94% for endoscopic US, 69% for CT, and 83% for MR imaging. Specificity was 100% for endoscopic US, 64% for CT, and 100% for MR imaging. Accuracy was 96% for endoscopic US, 67% for CT, and 84% for MR imaging. The sensitivity for the detection of tumors less than 3 cm in diameter was 93% for endoscopic US (n = 15), 53% for CT (n = 15), and 67% for MR imaging (n = 12). CONCLUSION: Endoscopic US is more accurate than dynamic CT and MR imaging in the diagnosis of pancreatic tumor, particularly for tumors less than 3 cm in diameter.

Carcinoma, Ductal, Breast↗
PubMed1993

[Transient eosinophilia in primary biliary cirrhosis].

We reviewed 144 differential white blood cell counts from 23 patients with primary biliary cirrhosis (PBC, 21 females, 2 males) for occurrence of eosinophilia. Over an average observation time of 43 +/- 9 months, 9/23 (39%, 9 female) patients were found to have transient absolute (> 500/mm3, n = 5) or relative (> or = 6%, n = 4) blood eosinophilia. The maximum value of eosinophilic granulocytes observed was 1385/mm3 (19%). Other causes of eosinophilia had been ruled out. Eosinophilia was transient, disappearing without treatment. Significantly younger patients with eosinophilia also had a tendency to prognostically more favourable values for serum albumin, prothrombin time, bilirubin and galactose elimination capacity. None had edema, compared to two patients with edema in the group without eosinophilia. Two patients died during the observation period; both were from the group without eosinophilia. The average 5- and 7-year survival probability, calculated on the Mayo survival model, tended to be higher for patients with eosinophilia (92% and 87%) compared to patients without eosinophilia (79% and 72%). In patients with eosinophilia, disease stage I (5/6 vs 1/9) and epitheloid cell granuloma (4/6 vs 1/9) were significantly more frequent. Blood eosinophilia in PBC seems to be an indicator of an early disease state with florid bile duct lesions. Primary biliary cirrhosis should therefore be considered--with other hepatopathies--as a possible cause of eosinophilia of otherwise unknown origin. These observations could be of importance for future therapeutic concepts, at least for patients in early disease states.

Adult↗
PubMed1993

[Bacterial infections following sclerosing therapy for esophageal varices].

Two patients with infectious complications 3 and 5 days after elective sclerotherapy of esophageal varices are presented. Both patients had liver cirrhosis (primary biliary cirrhosis and alcoholic liver cirrhosis with hepatitis B virus infection respectively). In one patient a brain abscess developed which was treated successfully by antibiotics and surgery; in the other patient pneumococcal bacteremia and gonarthritis developed. Frequency, possible causes and antibiotic prophylaxis are discussed.

Adult↗
PubMed1993

[Trans-jugular intrahepatic portosystemic stent-shunt (TIPS) in a patient with Budd-Chiari syndrome].

The surgical modalities for the management of Budd-Chiari syndrome are associated with high morbidity and mortality. The clinical course of a patient with subacute Budd-Chiari syndrome and a myeloproliferative disorder is described in whom, to reduce the portal hypertension, a transjugular intrahepatic portosystemic stent-shunt (TIPS) was implanted. TIPS is a new, still experimental procedure for the treatment of patients with portal hypertension which is used mainly for patients with recurrent variceal bleeding. An intrahepatic metal wire stent connects a main branch of the portal vein with a large hepatic vein and reduces the portal venous pressure as a side-to-side portosystemic shunt. In the patient described here the implantation of a TIPS was followed by rapid reduction of ascites production and a continuing general improvement.

Adult↗
PubMed1993

[A trial of modified triple therapy for the eradication of H. pylori in recurrent duodenal ulcer].

In a prospective trial we examined the efficacy and acceptability of a modified triple therapy in H. pylori (HP)-positive patients with recurrent duodenal ulcer disease. Oral administration of amoxicillin for two weeks was substituted for one single injection of intramuscular depot penicillin (benzathine penicillin G). Additionally, patients were given ornidazole 500 mg tid for 14 days and 120 mg colloidal bismuth sub-citrate qid for 28 days. The patients were investigated for H. pylori colonization using a rapid urease test (CLO), histology (H&E-, Giemsa stain), culture (including determination of the minimal inhibitory concentrations for metronidazole, penicillin G and amoxicillin) and H. pylori serology (Cobas Core Anti-H. pylori EIA, F. Hoffmann-La Roche). Control endoscopies using the same methods were performed 1 and 6 months after eradication therapy. The eradication rate was 50% and the ulcer healing rate 90% 1 month after therapy. Ulcers recurred in 2/3 of patients with persistent infection vs 0/5 of HP-eradicated patients after 6 months. Both successfully HP-eradicated patients and patients with treatment failure exhibited comparable decreases in mean serum IgG anti-HP concentration within 2 months. Discrimination between the two groups and hence identification of the eradication success by serology was not possible within a time period of 2 months. After 6 months, serum IgG anti-HP concentrations in non-HP-eradicated patients returned to pre-therapy values, in HP-eradicated patients the concentrations further decreased. The above-described modified triple therapy against HP cannot be recommended as a standard therapy, mainly because of the insufficient eradication effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Diverticulosis].

Diverticula of the colon are very common in developed countries. In most of those affected diverticulosis is an asymptomatic condition. Only 20% complain of recurrent symptoms. Symptomatic diverticulosis is common only after the age of 50. Dietary treatment combined with antispasmodics is generally sufficient. Diverticular disease is complicated by bleeding or by diverticulitis in 20% of symptomatic patients. Diverticulitis itself can be complicated by intra-abdominal abscess, fistulas, perforation with generalized peritonitis or bowel obstruction. Each clinical appearance is described and treatment is discussed.

Abscess↗
PubMed1992

[Comparison of the efficacy of omeprazole/bismuth subcitrate or triple therapy in Helicobacter pylori gastritis. A prospective controlled study].

UNLABELLED: In a controlled, prospective, randomized trial, 10 patients with Helicobacter pylori positive gastritis were treated either with triple therapy (tetracycline, ornidazole, bismuth subcitrate; T, Or, CBS), or omeprazole/CBS (O/CBS) to test the eradication rate of each treatment, its effect on gastritis and meal stimulated gastrin release. METHOD: 6 patients were treated with triple therapy and 4 patients with O/CBS for 2 weeks. Initially, and 0.5, 1, 3, 6, and 12 months after therapy, patients were investigated by a highly specific, quantitative Helicobacter serology, 13C-urea breath test and measurement of meal-stimulated gastrin release. After 3 and 12 months antral biopsies were taken endoscopically for rapid urease testing and culture. Activity of histological gastritis was graded. RESULTS: Eradication for at least 12 months was achieved in 5 out of 6 patients with triple therapy. Serology normalized and gastritis activity improved. In all patients treated with O/CBS, HP was suppressed only temporarily. No eradication was achieved. Urease testing and histology proved to be reliable tests for detecting HP. Culturing of HP was successful in only 66% due to technical problems. The 13C-urea breath test was correct in all cases. The initially, increased meal-stimulated gastrin release was normalized after eradication of HP. CONCLUSION: (1) Triple therapy is also successful in short term treatment in up to 80% of patients with HP gastritis and improves gastritis activity. (2) The combination O/CBS failed to eradicate HP in all treated patients. (3) The 13C-urea breath test and HP serology are reliable non-invasive parameters during follow-up. (4) Normalization of meal stimulated gastrin release after eradication of HP supports the hypothesis that HP induces increased gastrin release and hyperacidity.

Antacids↗
PubMed1989

[Endoprosthesis in the palliative treatment of malignant esophageal stenosis].

31 patients with inoperable malignancies of the esophagus were treated for severe dysphagia or fistula by endoscopic placement of an endoprosthesis. The mortality rate was 4%. 56% of the patients with dysphagia and 55% with fistulation experienced relief of symptoms. Complications occurred in about one third of all patients. Median patient survival after diagnosis was 9 months. Median survival after placement of the endoprosthesis was 25 days (25 and 75% quartiles 10 and 50 days, minimum and maximum 1 and 371 days respectively). Prior to placement of an endoprosthesis 66% of the patients had already been treated by chemotherapy, radiotherapy, repeated bougienage or laser photocoagulation. Almost all patients died as a result of their primary illness with the tube still in place. In patients with neoplastic fistulation palliative intubation is the therapy of choice. In addition to intubation, alternative methods are available today for treatment of severe dysphagia. However, further investigation is needed to determine the patients who will benefit most from the placement of a prosthesis.

Aged↗
PubMed1988

[Streptococcus bovis bacteremia and colonic diseases].

Four febrile patients were found to have a bacteraemia or endocarditis caused by Streptococcus bovis. Although there were no gastrointestinal symptoms, polyps in the colon, of a high degree of malignancy, were discovered in three. In the fourth, carcinoma of the colon, requiring resection, was found seven years after Streptococcus bovis endocarditis. The polyps were removed by endoscopy and the Streptococcus bovis infection in all cases cured by penicillin. All four patients had accompanying resistance-lowering illnesses, which favoured microbial invasion.

Adenocarcinoma↗
PubMed1987

Presenting characteristics of patients with duodenal ulcer and outcome of medical treatment in controlled clinical trials using cimetidine and diethylamine persilate to treat ulcer attack and diethylamine persilate and placebo to prevent relapses.

A double-blind controlled clinical trial on the medical treatment of the acute episode of duodenal ulcer and the prevention of symptomatic relapses was performed. A total of 164 patients with active duodenal ulcer were either treated with cimetidine 1 g/day (70 patients), diethylaminepersilate (DAP) 1.5 g/day (64 patients) or DAP 2.5 g/day (30 patients). DAP is an allegedly protective agent stimulating mucosal prostaglandin synthesis. Cumulative healing rates after 4 weeks in the 3 groups were 66, 28 and 28% and after 8 weeks 94, 70 and 63%, respectively. One hundred and five patients with healed duodenal ulcer received, in a second double-blind study, either DAP 0.5 g/day or placebo. Thus, ulcer healing was more rapid with cimetidine than with DAP. DAP did not prevent relapses. No presenting characteristic was associated with slow healing. Three presenting characteristics--smoking, teetotalling and bleeding episode in the past--were associated with early symptomatic relapse. The present study was compared with a previous study performed by the same group of investigators using a similar study protocol. In both trials, an early relapse was associated with smoking. No other presenting characteristic was identified which in both trials was associated with slow healing or early symptomatic relapse. Thus, smoking appears to be the only one of the commonly available presenting characteristics which allows a prediction of the course of duodenal ulcer disease.

Adult↗