[Pathologic-anatomic relations between peritonitis and sepsis].
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Bacterial Infections↗
Biomedical subjects
P Kratochvil
Publications and source records attributed to P Kratochvil.
[Endoscopic fistulotomy in choledocholithiasis].
In 9 cases of choledocholithiasis and 2 cases of endoscopically determined stenosis of the papilla in which an EPT could not be successfully performed it was possible to carry out a prepapillary choledochoduodenal fistula by means of endoscopy. Subsequently the fistula was split in the cranial direction using a papillotome, i.e. a fistulotomy was performed. The choledochal concrements disappeared spontaneously and the patients recovered successfully. In 4 further cases with an occlusion icterus, but with narrow ductus choledochus the common bile duct could not be cannulated. The endoscopic fistulotomy is only indicated when the common bile duct is dilated and if prior to the procedure and after failure of ERCP the indication for a surgical intervention is established through sonography or even better through PTC.
Aged↗
[Sonography in extensive juxtapapillary duodenal diverticulum].
The ultrasonic appearance of a juxtapapillary duodenal diverticulum as a pancreatic pseudo-mass is the subject of the discussion. An attempt is made to explain the homogeneous, echo-poor and solid aspect--even after rescanning through the fluid-filled stomach and duodenum and to correlate it with the diverticula's histological layers. The ERCP is the method of choice to examine the diverticula's inner wall and to investigate at the same time the frequently involved biliary tract and pancreatic diseases.
Aged↗
Treatment of duodenal ulcer with pirenzepine and cimetidine.
The purpose of this single blind controlled multicentre trial was to compare the relative effectiveness of pirenzepine and cimetidine in healing endoscopically proven duodenal ulcers. One hundred and twenty six patients with duodenal ulcer were treated with a daily dose of 100 mg pirenzepine (50 mg each before breakfast and before the evening meal), and 128 patients were treated with 1000 mg cimetidine (200 mg with breakfast, lunch, and evening meal and 400 mg at bedtime). Endoscopy was repeated after four weeks by an endoscopist who had not been informed about the treatment. Pirenzepine showed a healing rate of 64.3%, cimetidine one of 73.4%. This difference is not statistically significant (one-sided test: chi 1(2) = 2.48). After four weeks a higher proportion of first ulcers than of recurrent lesions was healed. Pain relief was rapidly achieved with both drugs. A significant trend in favour of cimetidine may, however, not be clinically relevant considering the small difference in the absolute numbers of pain free days and nights. Adverse effects were rare and reversible. We conclude that the efficacy of pirenzepine is similar to that of cimetidine in healing duodenal ulcers.
Anti-Ulcer Agents↗
Investigation of human bile and serum levels by high pressure liquid chromatography after administration of latamoxef or cefotaxime.
The high pressure liquid chromatography (HPLC) was used for the quantitative determination of R- and S-epimers of latamoxef, cefotaxime and desacetylcefotaxime in serum and bile. Bile levels of latamoxef, 1 and 2 h following administration of the antibiotic, were markedly above serum values. Those of cefotaxime, however, were identical after 1 h, after 2 h bile levels were below serum values. Desacetylcefotaxime concentration in bile after 1 and 2 h was four to five times higher than in serum. The ratio R-:S-epimer of latamoxef in serum was 49:51 after 1 and 2 h, in bile 44:56 after 1 h and 48:52 after 2 h. In the case of latamoxef the comparison of the microbiological and the HPLC assay showed good correlation (r = 0.98). The ratio cefotaxime: desacetylcefotaxime in serum was 72.5:27.5 after 1 h and 61.5:38.5 after 2 h, in bile 41:59 after 1 h and 24:76 after 2 h.
Aged↗
[Results of 2 years of long-term prevention of duodenal ulcer with cimetidine].
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Cimetidine↗
[Long-term results after endoscopic papillotomy].
A long-term control study after endoscopic papillotomy was performed in 102 patients at least 12 months after the procedure. 14 patients were no longer alive, from those only one patient died due to biliary problems. Complications occurred in 10 patients (9,8%). There was no cholangitis, but 2 cases of an acute cholecystitis some time after papillotomy. Therefore a cholecystectomy after papillotomy is suggested in the interval.
Aged↗
[Effect of ciclotropium bromide on pressure in the human common bile duct].
The effect of a new anticholinergic drug, ciclotropium bromide, on artificially induced pressure elevations in the common bile duct is reported. The endoscopic manometry allows a precise pressure measurement in the biliary system. For the artificial pressure elevation an X-ray contrast medium was injected into the common bile duct until the pain threshold was reached. In each patient a statistically significant pressure reduction accompanied by pain relief was reached. The method used shows the drug effects by objective measurement of the pressure reduction and the subjective indication of the pain relief.
Bridged Bicyclo Compounds, Heterocyclic↗
[Endoscopic manometry in the common bile duct].
Reproducible results were obtained by endoscopic transpapillary pressure measurements with the help of a constantly perfused catheter. Manometric measurements were performed in 51 patients without any premedication. 14 patients with a normal biliary system were compared with 17 patients after cholecystectomy, 14 patients with stones in the common bile duct and 6 patients after papillotomy. Although there were significant differences in the diameter of the common bile duct in the four groups, only the papillotomized patients demonstrated a distinct change of the pressure in the bile duct. In these patients almost no pressure gradient existed between the biliary ducts and the duodenum. On the other hand, there was an increase in intraluminal pressure in the 2 patients with papillary stenosis. Endoscopic manometric measurements in the common bile duct are indicated to obtain reliable data on stenosis of the papilla duodeni, insufficient papillotomy or recurrent stenosis.
Aged↗
[Necrosis of pancreas after endoscopic retrograde pancreaticography (author's transl)].
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Adult↗
[Mezlocillin and oxacillin concentrations in the bile of the choledochus].
The purpose of this study was to determine the antibiotic concentrations in serum and bile one and two hours after the completion of a simultaneous short-term infusion of 4 g mezlocillin and 2 g oxacillin. Seven patients were studied. Bile was withdrawn from the bile duct by means of a Teflon catheter. The mean serum concentrations of mezlocillin were 130.4 mg/l and 60.8 mg/l one and two hours after the end of the infusion, respectively. The mean serum concentrations of oxacillin determined at the same times were 57.9 mg/l and 18.9 mg/l, respectively. The mean biliary levels of mezlocillin were 3215.6 mg/l and 2483.1 mg/l one and two hours after the end of the infusion, respectively. The corresponding mean biliary values for oxacillin were 497.3 mg/l and 205.5 mg/l.
Aged↗
Effect of smoking on duodenal ulcer healing with cimetidine and oxmetidine.
The effect of oxmetidine 800 mg/day, a new histamine H2-receptor antagonist, on duodenal ulcer healing was compared with cimetidine 1000 mg/day in a two-centre double-blind trial. Ninety-nine patients completed the study. After four weeks, ulcers were healed in 74% of the cimetidine-treated patients and in 78% of the oxmetidine-treated patients (p greater than 0.05). Healing rates after eight weeks increased to 90% in the cimetidine group and to 94% in the oxmetidine group. Healing rates after four weeks were, however, different in the two centres (p less than 0.01): in centre 1 88% of the cimetidine-treated, but 63% of the oxmetidine-treated patients healed, in centre 2 rates were 60% (cimetidine) and 92% (oxmetidine). Analysis of patient data revealed that in the two centres treatment success was inversely correlated (p less than 0.01) with the percentage of smokers in each treatment group. Smoking significantly influences duodenal ulcer healing with histamine H2-receptor antagonists.
Adult↗
[Endoscopic papillotomy in Austria].
In 5 gastroenterologic centres in Austria 383 EPT were performed at a total of 10031 ERCP until July 1980. In 350 cases this procedure was successful (91.3%). The most frequent indication was a choledocholithiasis in 300 cases (85.7%). Complete disappearance of gall stones was achieved in 94%. Complications happened in 14 patients (4%), in 4 patients (12%) surgical procedures were necessary consequently. The death rate was 0.6% (2 patients). These favorable results and the low rates of complications and letality of this procedure encourage for the more frequent use of this method for the treatment of choledocholithiasis also in Austria in capable and experienced hands. In view of reducing complications the limitation of the EPT to few specialised centres is demanded.
Ampulla of Vater↗
[Tumor diagnostic by ERPC and its correlation to pathology (author's transl)].
In relation to 170 pancreatic and bile duct neoplasms confirmed by histology, the radiological signs were correlated to anatomical findings. The roentgenograms were analysed with regard to diagnostic accuracy, size of tumor and operability. 13 319 autopsies of the same period were screened in order to ascertain false positive and as well false negative findings in ERPC. Pancreatic tumors with a diameter over 3 cm were correctly found by ERPC in 98,4%, tumors below 3 cm in diameter in 75%. The over-all diagnostic accuracy for malignant tumors was 90,0%. There were no pathological findings in ERPC in two cases of pancreatic cancer with diameter below 3 cm. 10,5% of all pancreatic neoplasms were operable. Tumors of extrahepatic bile ducts all were discovered by ERPC but all of them were already inoperable.
Aged↗
[Experience with endoscopic papillotomy (author's transl)].
The results of 64 endoscopic papillotomies (EPT) are reported. When precautions are taken the EPT is a highly effective procedure of low risk. The minimal stress for the patient, the high accuracy and the low number of complications guarantee this method a prominent place in the treatment of bile duct illnesses. Control examinations of 30 patients to 12 months after operation proved all patients symptom-free and neither biochemical nor clinical evidence of cholangitis or other complications.
Adult↗
[Endoscopic retrograde cholangio-pancreaticography (ERCP) and computer tomography in the diagnosis of chronic pancreatitis, pseudocysts and carcinoma of the pancreas--a comparison (author's transl)].
In 107 patients, endoscopic retrograde cholangiopancreaticography (ERCP) and computer tomography (CT) were performed at a short time interval. The combined use of ERCP and CT yielded a correct diagnosis in chronic pancreatitis in 92% of the patients; pseudocysts were diagnosed correctly in 100% of the cases, whereas the rate of accuracy in carcinomas was 94%. In chronic pancreatitis, ERCP usually gave clear and comprehensive information. CT proved a valuable additional examination method wherever the findings did not supply a clear answer. Both examination method were ideally complementary in pseudocysts, so that ERCP and CT were found to be appropriate in each case. In carcinoma, ERCP proved superior to primary diagnosis, whereas CT served to confirm the findings and to assess the volume occupied by the tumor.
Adult↗
[Endoscopic polypectomy in the colon (author's transl)].
A report is given on the endoscopic removal of 81 polyps of the colon by means of high frequency diathermy. This procedure proved to be without risk to the patient and has largely replaced surgical removal by laparotomy as the method of choice today. Total removal of the polyp with subsequent histological examination is naturally imperative to avoid unnecessary subsequent radical surgical procedures. Since most colonic carcinomas arise in the base of a polyp, polypectomy represents a true prophylactic measure and, in some cases, a therapeutic one.
Adenocarcinoma↗
[Endoscopic sphincterotomy and removal of a gallstone from the common bile duct (author's transl)].
Twenty-one patients with an average age of 69 years were subjected to endoscopic sphincterotomy of the papilla of Vater over the past six months. This therapeutic approach was successful and without ensuring complications in 20 of these patients. Hence, endoscopic sphincterotomy can be recommended in the case of elderly or high-risk patients as an alternative form of therapy to surgery with the attendent dangers of anaesthesia and, in particular, duodenotomy. However, it is unlikely to become a routine procedure since a team of highly-experienced specialists in endoscopy is mandatory with the close cooperation of radiologists and surgeons. The technique, indications and complications are mentioned.
Age Factors↗