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Biomedical subjects

T Sauerbruch

Publications and source records attributed to T Sauerbruch.

At least 325 records · Page 18Linked to original sources
PubMed1990

[Treatment of hemorrhage of esophageal varices].

Portal hypertension may be caused by portal venous outflow obstruction, an increased portal venous inflow due to a hyperdynamic circulation or both. Portal venous collaterals usually develop above a threshold portal venous pressure of 10 to 12 mm Hg. Only about one third of patients with esophageal varices eventually bleed. However, the mortality in patients who do bleed is high (around 50%) mostly because patients frequently die prior to hospital admission. Immediate endoscopy for precise location of site of bleeding is essential. Bleeding then may be controlled by drugs which lower portal pressure, balloon-tube tamponade or emergency injection sclerotherapy. Of these therapeutic options sclerotherapy probably has the highest success rate for the acute control of variceal bleeding. It can in addition be combined with the initial endoscopic diagnostic procedure, and repeated injection sclerotherapy can reduce the incidence of recurrent variceal bleeding. Portasystemic shunts, transection and devascularisation operations are nowadays only used in patients in whom repeated sclerotherapy had failed. Beta-blocking agents may be an alternative for long-term management after variceal bleeding, although the results are controversial. The data regarding prophylaxis of first variceal hemorrhage are conflicting. Prophylactic regimens should only be carried out in the form of controlled trials.

Balloon Occlusion↗
PubMed1990

[Extracorporeal shockwave lithotripsy of pancreatic calculi].

Using extracorporeal shock wave lithotripsy (ESWL) pancreatic stones may be disintegrated. Acute adverse effects directly attributably to shock wave lithotripsy are rare. More than half of the patients will exhibit complete clearance of the pancreatic duct system after ESWL, endoscopic sphincterotomy and extraction of fragments. Most of the patients in whom the ducts could be cleared from the stones also showed improvement of chronic pancreatic pain. These findings, however, have to be substantiated by larger clinical studies with longer follow-up periods.

Calculi↗
PubMed1990

The place of lithotripsy and surgery in the management of gallstone disease.

In summary, 10% to 20% of all symptomatic and uncomplicated gallbladder stones can be treated by ESWL under the current entry criteria. Further, ESWL is suitable for patients with bile duct stones in whom the primary endoscopic approach is not successful (about 10%). The algorithm in Figure 7 shows the therapeutic modalities that may be employed if the least invasive therapy is chosen. The different methods shown in this diagram are usually carried out by different specialists including surgeons, gastroenterologists, or radiologists. Therefore, an interdisciplinary approach is desirable. The technology of shock wave therapy of gallbladder stones will be improved in the future, for example the efficacy of stone fragmentation while maintaining a low level of discomfort for the patient. Moreover, repeated shock wave treatments may increase the success rate in patients with multiple stones and possibly in those with slightly calcified stones as well. Repeated procedures for recurrent stones appear feasible. Long-term follow-up studies are needed to define the place of ESWL in the management of gallstone disease. Surgery of the gallbladder remains the "gold standard" of curative therapy of gallbladder stones, against which ESWL and other nonsurgical techniques have to be evaluated. For the therapy of bile duct stones, ESWL is a helpful and effective nonsurgical adjunct.

Animals↗
PubMed1989

Atrial natriuretic factor and renin-aldosterone in volume regulation of patients with cirrhosis.

The role of the atrial natriuretic factor and of the main counteracting sodium-retaining principle, the renin-aldosterone system, in acute volume regulation of cirrhosis of the liver has been investigated. Central volume stimulation was achieved in 21 patients with cirrhosis, 11 without and 10 with ascites, and 25 healthy controls by 1-hr head-out water immersion. Immersion prompted a highly significant (p less than 0.001) increase of atrial natriuretic factor plasma concentrations in cirrhotic patients without ascites from 8.5 +/- 1.3 fmoles per ml to 16.5 +/- 2.6 fmoles per ml, comparable to the stimulation in control subjects (6.0 +/- 0.6 fmoles per ml to 13.6 +/- 2.6 fmoles per ml). In cirrhotic patients with ascites, atrial natriuretic factor increase (from 7.7 +/- 1.3 fmoles per ml to 11.4 +/- 2.3 fmoles per ml) was blunted (p less than 0.05). Plasma renin activity and plasma aldosterone concentration were elevated in cirrhotic patients, especially in the presence of ascites. Following immersion, plasma renin activity and plasma aldosterone concentration were reduced similarly in all groups. Water immersion induced a more pronounced natriuresis and diuresis in control subjects than in cirrhotic patients. Neither atrial natriuretic factor nor plasma renin activity nor plasma aldosterone concentration alone correlated to sodium excretion. However, atrial natriuretic factor to plasma aldosterone concentration ratios were closely correlated to basal and stimulated natriuresis in cirrhotic patients, particularly in those with ascites. These data suggest that atrial natriuretic factor and the renin-aldosterone system influence volume regulation in patients with cirrhosis.

Adult↗
PubMed1989

Gallstone lithotripsy by extracorporeal shock waves.

Extracorporeal shock-wave lithotripsy (ESWL) in combination with adjuvant litholytic therapy using chenodeoxycholic acid and ursodeoxycholic acid (7 to 8 mg/kg body weight/day of each acid) is a safe and effective, novel nonsurgical approach to gallbladder stones, provided the patients are carefully selected. Experience has shown that patients with a radiolucent solitary stone in a functioning gallbladder are the best candidates. In addition, ESWL is a worthwhile noninvasive alternative to open surgery in patients with bile duct stones in whom routine endoscopic measures have failed.

Cholelithiasis↗
PubMed1989

Shock-wave therapy of gastric outlet syndrome caused by a gallstone.

A patient with gastric outlet syndrome (Bouveret's syndrome) caused by a large gallstone impacted in the duodenal bulb was successfully treated by extracorporeal shock-wave lithotripsy. Thus, open abdominal surgery could be avoided. For disintegration of the stone, three consecutive lithotripsy procedures were necessary. Thereafter, stone fragments could be extracted endoscopically. Extracorporeal shock-wave lithotripsy could become a non-surgical alternative in patients with obstruction of the duodenum caused by a gallstone.

Aged↗
PubMed1989

Fragmentation of bile duct stones by extracorporeal shock waves. A new approach to biliary calculi after failure of routine endoscopic measures.

A prospective uncontrolled multicenter trial was performed on 113 patients with bile duct stones in whom routine endoscopic approaches for removal of the calculi had failed. These represented 8.3% of the patients referred to the participating centers for endoscopic extraction of the stones. Extracorporeal shock-wave lithotripsy using the Dornier kidney lithotripter achieved stone disintegration in 103 patients (91%). Complete stone clearance from the bile ducts was obtained in 97 patients (86%) after a median of 4 days following extracorporeal shock-wave lithotripsy. Adverse effects, mostly mild, occurred in 36% of the patients. A 30-day mortality rate of 0.9% (in-hospital mortality rate = 1.8%) of this high-risk group with a mean age of 72 yr and a cholangitis rate of 26% compared favorably with the data given for open surgery. We therefore consider extracorporeal shock-wave lithotripsy a useful method for the treatment of bile duct stones not amenable to routine endoscopic measures.

Aged↗
PubMed1989

[Percutaneous drainage of fistula-associated abscesses and biliary fistulas].

33 abdominal abscesses associated with fistulae in 31 patients were treated by percutaneous drainage. 19 of these patients had had surgery immediately preceding the drainage. In 64% the percutaneous drainage led to a diagnosis of an internal fistula. Additional therapeutic measures, because of the fistula, were necessary in 45% (operation, biliary drainage, repositioning of catheter). The average duration of drainage was 29 days. 77% of those abscesses which could be drained were treated successfully. Mortality in the entire series was 19%.

Abdomen↗
PubMed1989

Extracorporeal shock wave lithotripsy of pancreatic stones.

Extracorporeal shock wave lithotripsy of pancreatic stones was performed in eight patients with chronic pancreatitis and a dilated duct system harbouring stones 5 to 20 mm (means 10 (SD) 5 mm) in diameter. After endoscopic sphincterotomy of the pancreatic orifice the stones were disintegrated by shock waves under fluoroscopic control using a kidney lithotripter (Dornier HM3). The procedure was well tolerated by all but one patient, who had a mild pancreatitic attack immediately after lithotripsy. Clearance of the pancreatic duct systems from the larger stones was achieved in seven of eight patients. Half of the patients showed no improvement in the intensity and frequency of pain. The other patients had a marked amelioration of symptoms, however, both immediately and during a mean follow up interval of 11 (eight) months. A selective combined approach by endoscopy and extracorporeal shock wave lithotripsy for the treatment of pancreatic stones seems promising.

Adult↗
PubMed1989

Pressure of intraoesophageal varices assessed by fine needle puncture: its relation to endoscopic signs and severity of liver disease in patients with cirrhosis.

In 40 patients with cirrhosis and oesophageal varices transmural variceal pressure was assessed endoscopically by fine needle puncture and related to endoscopic signs as well as to the severity of liver disease. Transmural pressure was significantly (p less than 0.01) higher in the presence of a red colour sign (26.7 (7.8) cm H2O) than in its absence (19.1 (6.6) cm H2O). Transmural pressure, however, was not significantly related to diameter or number of varices (diameter greater than 5 mm: 23.7 (8.4), diameter less than or equal to 5 mm: 22.2 (7.9) cm H2O; number greater than 3: 23.2 (8.0), number less than or equal to 3: 22.2 (7.8) cm H2O). The Child status (Child A: 23.9 (8.0), Child B/C: 21.3 (8.1) cm H2O) and individual Child-Pugh parameters including ascites (ascites present: 23.2 (8.3) cm H2O ascites absent: 22.8 (8.1) cm H2O) were not significantly related to transmural variceal pressure. We conclude that the endoscopic visibility of a red colour sign on the varices is associated with a high transmural oesophageal variceal pressure. Our results favour the hypothesis that variceal pressure may be of major importance for the development of the red colour sign.

Ascites↗
PubMed1989

Topographic association between active gastritis and Campylobacter pylori colonisation.

One thousand biopsy specimens obtained from 10 sites in the stomachs of 50 patients were examined for the presence of active chronic gastritis and Campylobacter pylori. All 32 patients with active chronic gastritis at 234 out of 320 sites were positive for C pylori: 227 showed colonisation with C pylori by the Warthin-Starry stain; and 222 were positive by culture. C pylori was not found in 18 patients with inactive chronic gastritis or histologically normal mucosa. The area of C pylori colonisation was larger than the area of active chronic gastritis in 289 positive specimens on culture and 261 on staining, respectively, suggesting that C pylori colonisation may precede the development of active chronic gastritis. It is concluded that patchy distribution of active chronic gastritis and C pylori colonisation must be considered, particularly in serology or breath test studies where the histological examination serves as a reference. Furthermore, it may have important implications for the follow up of patients after antibacterial treatment. The topographic and specific association of C pylori and active chronic gastritis provides further evidence for the pathogenic role of C pylori in active chronic gastritis.

Adult↗