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Biomedical subjects

P Matzen

Publications and source records attributed to P Matzen.

At least 37 records · Page 2Linked to original sources
PubMed1996

No effect of oxygen therapy on myocardial ischaemia during gastroscopy.

BACKGROUND: Myocardial ischaemia (defined as an ST-segment depression on ECG) may occur during upper gastrointestinal endoscopy, but the mechanism is still unknown. The aim of our study was to evaluate the effect of oxygen therapy and tachycardia on the occurrence of ST-segment depression during routine diagnostic esophagogastroduodenoscopy. METHODS: Eighty-nine consecutive patients were randomized to receive either oxygen (21/min by nasal prongs) or nothing during endoscopy, in which arterial oxygen saturation was measured by continuous pulse oximetry, and ECG was measured continuously with a Holter tape recorder. RESULTS: A total of 28 patients (12 receiving oxygen) developed ST-segment depression ( > 0.1 mV) during endoscopy. In 22 patients (12 receiving oxygen) ST depression was related to tachycardia, and in 5 of these (none receiving oxygen) simultaneous episodic hypoxaemia was present during the event. Thus, in every case of ST depression related to episodic hypoxaemia there was simultaneous tachycardia. In six patients developing ST depression during endoscopy we did not find preendoscopy levels, and 63 patients (29 receiving oxygen) developed tachycardia during the procedure (rate > 100 min-1_. CONCLUSIONS: Oxygen therapy had no significant effect on the occurrence of ST-segment depression during upper gastrointestinal endoscopy. The results suggest that tachycardia is more important than hypoxaemia in the pathogenesis of ST depression during gastroscopy.

Adult↗
PubMed1995

Hands-on endoscopy training: an evaluation of the SADE endoscopy course. Scandinavian Association of Digestive Endoscopy.

The Scandinavian Association of Digestive Endoscopy course in advanced practical endoscopy has been arranged on a regular basis since 1980, representing a joint Scandinavian effort to offer hands-on endoscopy training with expert supervision at major endoscopy centers. The course has been aimed at gastroenterologists with previous endoscopic experience, focusing on special techniques, practical hints and expert solutions in special cases. Three days of practical training throughout Scandinavia are completed with two days of review lectures, case reports and special techniques. An inquiry among previous course participants indicates that the course has indeed been of practical value for their daily work, and that personal training as well as watching "experts at work" were useful for their ensuing endoscopic practice. The course model does, however, require close co-operation with the endoscopy units hosting the practical part of the course.

Curriculum↗
PubMed1994

[Percutaneous endoscopic gastrostomy. A retrospective study of the course and complications].

To assess mortality, morbidity and outcome of percutaneous endoscopic gastrostomy (PEG) we retrospectively studied 67 patients. PEG was successful in 65 patients (success rate, 97%). PEG was used as the procedure of choice when enteral feeding was needed. PEG was performed employing an introducer-technique and a Danish developed gastrostomy tube. The most common indication for PEG were neurological diseases (45 patients (69%)), trauma and malignant disorders (17 patients (26%)). Oral intake recovered in 18 patients (28%) who then had the tube removed, 25 patients (38%) were discharged with the gastrostomy, 13 patients (20%) died from their primary disease and five patients with PEG remained in hospital, PEG was removed in three patients due to intolerance to enteral feeding (two patients) or stomal leak (one patient). The total complication rate was 8% with three major complications (one procedure-related death). We recommend PEG for both short and long-term feeding.

Adolescent↗
PubMed1994

Budesonide versus prednisolone retention enemas in active distal ulcerative colitis.

METHODS: Efficacy and safety of the topically acting glucocorticosteroid budesonide retention enema (2.3 mg/115 mL) were compared with prednisolone disodium phosphate enema (31.25 mg/125 mL) in patients with active distal ulcerative colitis. The study was a randomized, multicentre trial, with two parallel groups and single-blind to the investigator. One hundred patients with active ulcerative colitis, not reaching beyond the splenic flexure as determined by endoscopy, were treated for up to 8 weeks. RESULTS: Forty-five patients were randomized to receive budesonide and 55 to prednisolone. Both treatment groups improved significantly in terms of endoscopic and histological scoring during the study, but there were no statistically significant differences between the two groups. Clinical remission, defined as no more than three daily bowel movements without blood and endoscopically non-inflamed mucosa, was achieved in 16% of the patients in the budesonide group after four weeks and in 24% in the prednisolone group (N.S.). After 8 weeks treatment the clinical remission rate in the groups had increased to 36% for budesonide and 47% for prednisolone (N.S.). Mean morning plasma cortisol levels were unchanged in the budesonide group, whereas they were significantly suppressed in the prednisolone group after 2, 4 and 8 weeks (P < 0.0001). Side effects were mild and rare in both groups. CONCLUSIONS: Treatment with budesonide enema in active distal ulcerative colitis was comparable, regarding efficacy, to treatment with conventional prednisolone enema. A prolongation of the treatment time from 4 to 8 weeks doubled the clinical remission rate in both groups. However, budesonide may be preferable to prednisolone since it causes less systemic effects as reflected by a lack of plasma cortisol suppression.

Adult↗
PubMed1994

Opinions in Denmark on the causes of peptic ulcer disease. A survey among Danish physicians and patients.

The aim of the study was to investigate opinions among Danish patients and physicians on causes of peptic ulcer disease. Fifty-nine patients with an ulcer history and 77 physicians with a special interest in gastroenterology participated. They were given a questionnaire listing 16 possible causes of peptic ulcer and indicated for each whether they believed it was a contributory cause of the disease. The patients stated 0-10 causes each (median, 4), and the physicians 3-12 causes (median, 6) (p < 0.01). Younger physicians stated more causes than did the older ones (p < 0.01), and female physicians stated more causes than did their male colleagues (p < 0.01). Seventy-five per cent of the patients indicated that psychologic factors, such as grief, anxiety, and stress, were contributory causes of peptic ulcer disease, whereas only around 40% believed that coffee/tea, alcohol, smoking, side effects of medicine, and working conditions played a causal role. Around 95% of the physicians indicated that medical drugs and smoking were contributory causes of peptic ulcer disease, and around 80% that alcohol and psychologic factors were so. Only 30-40% of the physicians believed that coffee/tea, food habits, infection, and working conditions could play a causal role in ulcer disease. It is concluded that the opinion on causal agents in peptic ulcer disease differ considerably among both patients and physicians. Opinions on causes of diseases may influence the way we treat and advise our patients, and attempts should thus be made to unify our knowledge and interpretations of causes of diseases to reach more solid ground in counselling our patients.

Adult↗
PubMed1992

Longitudinal study of influence of Helicobacter pylori on current risk of duodenal ulcer relapse. The Hvidovre Ulcer Project Group.

Seventy-four patients with duodenal ulcer were followed up longitudinally for 2 years after initial ulcer healing. Endoscopy including biopsy of the antral mucosa was performed every 3rd month and whenever clinical symptoms of relapse occurred. The presence of Helicobacter pylori in the biopsy specimens was scored as 0 (none), 1 (sporadic occurrence), 2 (clusters), and 3 (numerous bacteria found diffusely in the mucus layer). The incidence rates of ulcer relapse per patient-month, grouped in accordance with these scores, were (with 95% confidence intervals) 0.073 (0.048-0.111), 0.083 (0.052-0.133), 0.123 (0.096-0.157), and 0.069 (0.041-0.116), respectively. No significant differences in incidence rates across H. pylori scores were observed when taking into account the observation period after healing of the first ulcer, number of ulcer recurrence (1st, 2nd, 3rd), sex, age, smoking habits, peak acid output, time of healing of the preceding ulcer, treatment of the present ulcer (cimetidine, antacids, or no treatment), or type and degree of gastritis. Thus, although H. pylori is prevalent in patients with duodenal ulcer disease, the present study indicates that H. pylori does not have a substantial note in the precipitation of active duodenal ulcer.

Adult↗
PubMed1992

Experimental clogging of biliary endoprostheses. Role of bacteria, endoprosthesis material, and design.

The major problem facing patients treated with biliary endoprostheses is their frequent clogging, necessitating their exchange. Clogged endoprostheses contain mainly bacteria embedded in an amorphous proteinaceous material with the occasional presence of food fibres. We studied this problem in an in vitro model, evaluating the role of bacteria, endoprosthesis design, and material in sludge formation. We found endoprostheses perfused with artificially contaminated bile to contain significantly more sludge than those perfused with sterile bile (p less than 0.05). The amount of sludge varied with the bacterial species used. Endoprostheses perfused with bacteria producing beta-glucuronidase were not associated with a particularly large amount of sludge. Endoprostheses with side holes contained significantly more sludge than those without (p less than 0.05). Furthermore, endoprostheses made of material with a low friction coefficient, such as Teflon, contained significantly less sludge than endoprostheses made of materials with a higher friction coefficient, such as polyethylene and polyurethane (p less than 0.05). These results emphasize the role of bacteria in endoprostheses clogging and clearly demonstrate the harmful effect that side holes have on endoprosthesis function.

Biliary Tract Surgical Procedures↗
PubMed1991

[Endoscopic percutaneous transhepatic cholelithotripsy in the treatment of complicated stones in the deep biliary tracts].

The results of endoscopic percutaneous transhepatic cholelithotripsy in seven patients with stones in the deep biliary passages which could not be treated by endoscopic papillotomy (EST) or extracorporeal shock wave lithotripsy (ESWL) are presented. A new dilator technique combined with mechanical or laser-lithotripsy was employed. All of the patients were relieved of the stones after uncomplicated course. It is concluded that endoscopic percutaneous cholelithotripsy which can be carried out under local anaesthesia, should be offered to patients with stones in the deep biliary passages which are not accessible to conventional treatment with EST or ESWL.

Aged↗
PubMed1991

[Duodenal ulcer in systemic mastocytosis].

Two cases of systemic mastocytosis are presented. Both patients had peptic ulceration. Greatly raised values on investigation of gastric acid secretion in patients with therapy-resistant peptic ulceration and normal serum gastrin should raise the suspicion of systemic mastocytosis.

Adult↗
PubMed1991

[Extracorporeal shockwave crushing of gallstones. Preliminary report].

Extracorporeal shock wave lithotripsy (ESWL) was used for treatment of symptomatic x-ray negative stones in 23 patients. The number of ESWL sessions per patient was 1.8 (range 1-4). In 18 patients (78%), adequate fragmentation was seen comparable to results obtained elsewhere. Oral bile acid therapy was used after ESWL in the 18 patients mentioned and the mean follow-up period was five months (range 3-8 months). Four patients had by now passed all stones while 12 patients still had remaining stone fragments and one patient a gallstone. After ESWL, one patient was and one patient a gallstone. After ESWL, one patient was referred for cholecystectomy at his own request. Of the remaining five patients, cholecystectomy was performed in two and was scheduled for in three. Complications after ESWL were seen in two patients who developed acute pancreatitis. Thus, our preliminary experience shows that ESWL resulted in fragmentation and passing of gallbladder stones, but not without complications. Like the gallstone groups in Lyon, Montreal and Munich we are convinced that ESWL should be performed in accordance with prospectively designed protocols in order to establish optimal planning of indications and strategies for future treatment.

Adult↗
PubMed1991

Ultrasound examination in jaundiced patients. Is computer-assisted preclassification helpful?

In this study we attempted to determine the diagnostic accuracy and reproducibility of ultrasonography (US) for jaundice and to see how US can best be combined with preliminary clinical-biochemical diagnoses to plan the invasive work-up. US proved reproducible in two diagnostic departments (127 agreements in 135 cases). But, since obstruction was underdiagnosed (15 double-false negatives), the predictive value of a negative result was only 0.83. By adding a term which represents the US conclusion, obstruction or not, to the Copenhagen pocket diagnostic chart score (based on the logistic model) we found that an obstructive conclusion increases the odds of obstruction by a factor of 25, and a non-obstructive conclusion decreases the odds by a factor of only 1.9. We conclude that the preliminary diagnosis is frequently sufficiently certain to be unalterable by US. This leaves only 40% of the jaundice cases in which US is necessary to plan invasive work-up. The US workload can even, it appears, be reduced to about 22% without appreciable penalty in terms of unrewarding invasive procedures. Using these strict indications, four US examinations seem to suffice to avoid one such error. Relying on either US or clinical-biochemical data alone is inferior to the combined strategy.

Algorithms↗
PubMed1991

Clogging and other complications of endoscopic biliary endoprostheses.

This study included 236 patients treated with endoscopic biliary endoprostheses. Malignant strictures were responsible for the obstruction in 87% of the patients. The 1-week and 1-month mortality for patients with malignant strictures was 10% and 22%, respectively, whereas that of patients with benign conditions was 3% and 10%, respectively. The major complication encountered was the frequent hospital readmissions of patients owing to clogging of their endoprostheses. Late clogging had an overall occurrence of 33% and presented with recurrence of jaundice with or without fever or pain. Late signs of cholangitis occurred in 15% of the patients, whereas other late complications were rather infrequent. Although 10-french endoprostheses had a significantly longer patency period than 7-french--that is, 6 months versus 2 months (p = 0.01)--the proportion of patients in whom clogging occurred was nearly the same, 30% for 10-french and 32% for 7-french endoprostheses.

Adult↗