Search PubMed⌕ Search

Biomedical subjects

T Sauerbruch

Publications and source records attributed to T Sauerbruch.

At least 379 records · Page 21Linked to original sources
PubMed1986

Prophylaxis of first variceal hemorrhage in patients with liver cirrhosis.

Prophylaxis of bleeding from esophageal varices is a very tempting concept at first glance, especially under the assumption of a high mortality associated with first variceal hemorrhage. Up to now four different measures have been tried for prophylaxis: portacaval shunt operation, devascularization procedures, sclerotherapy, and drugs. With the exception of portacaval shunts, ongoing controlled trials show a weak trend toward reduction of variceal bleeding and prolongation of survival in selected patients with compensated cirrhosis and large varices. However, prophylaxis of first variceal bleeding must still be regarded as experimental and should be restricted to controlled clinical studies.

Adrenergic beta-Antagonists↗
PubMed1986

Evidence for down-regulation of beta-2-adrenoceptors in cirrhotic patients with severe ascites.

The density and affinity of beta-2-adrenoceptors on mononuclear cells from peripheral blood were studied in fifteen patients with cirrhosis of different severity and in thirteen controls. There was no significant difference between cirrhotic patients and controls in density or affinity of beta-2 binding sites. Within the cirrhotic group, however, the number of binding sites per cell was significantly lower in patients with severe ascites than in patients with mild to moderate or no ascites. This down-regulation of beta-adrenoceptors could influence the haemodynamic response to beta-blockers.

Adrenergic beta-Antagonists↗
PubMed1986

Fragmentation of gallstones by extracorporeal shock waves.

We treated nine patients with functioning gallbladders containing one to three symptomatic radiolucent stones not larger than 25 mm in diameter, as well as five patients with stones in the common bile duct that were not removable by endoscopic procedures, by means of extracorporeally generated shock waves during general anesthesia. The patients with gallbladder stones received adjuvant treatment with a combination of ursodeoxycholic acid and chenodeoxycholic acid. All gallbladder stones were disintegrated into sludge or fragments with diameters of no more than 8 mm. In six of the nine patients the fragments disappeared completely within 1 to 25 weeks. No adverse effects were detected during a follow-up period of 10 to 34 weeks, except transient biliary pain in two patients, with mild pancreatitis in one. In four of the five patients with common-bile-duct stones, shock-wave treatment permitted stone disintegration and successful endoscopic extraction or spontaneous passage of fragments. We conclude that gallstone disease may be treated successfully and without serious adverse effects by extracorporeally generated shock waves in selected patients.

Adult↗
PubMed1986

Effects of repeated injection sclerotherapy on acid gastroesophageal reflux.

Acid gastroesophageal reflux was determined by long-term pH monitoring in 19 consecutive variceal bleeders after 5 to 20 (mean, 10.3 +/- 1 SEM) sclerotherapy sessions with the flexible endoscope using polidocanol 1% as sclerosant. Fifteen cirrhotics with untreated varices served as controls. Percentage time of esophageal pH less than 4 (3.3 +/- 0.7 SEM vs. 5.2 +/- 2.2 in the controls) and mean duration of reflux episodes (2.9 +/- 0.4 vs. 3.0 +/- 0.7 min) showed no significant differences between both groups. The findings indicate that repeated injection sclerotherapy with the flexible endoscope does not lead to an enhancement of acid gastroesophageal reflux.

Esophageal and Gastric Varices↗
PubMed1986

In vitro cholesterol gallstone dissolution after fragmentation with shock waves.

In order to test whether shock wave fragmentation of human gallstones increases their dissolution rates in a bile acid-lecithin solution, we carried out in vitro experiments. Stones comparable in size, weight and cholesterol content (86%) from the same human gallbladder were disintegrated by shock waves. A glycoursodeoxycholic acid (GUDC)-lecithin solution served as solvent. After 10 days incubation in this solvent, intact stones had lost only 4% of their cholesterol. This value increased to 92% after disintegration of the stones by 300 shock wave discharges. Fragments with a size of less than 2 mm had lost 55% of their cholesterol after day 1 and 99% after day 10. A large stone fragment cleaved off by shock waves lost much more cholesterol (42% after 10 days) than an intact untreated stone (4% after 10 days) comparable in size, weight and cholesterol content. These data show that shock wave lithotripsy of cholesterol gallstones considerably accelerates their dissolution rate in a GUDC-lecithin solvent, the desirable fragment size being 2 mm or less. However, even large fragments may lose much more cholesterol than comparable intact stones as a result of changes in surface structure as documented by scanning electron microscopy. The experiments favor the concept of a combined treatment of gallbladder stones by extracorporeally generated shock waves and bile salt therapy.

Cholelithiasis↗
PubMed1986

Influence of long-term injection sclerotherapy on portal venous component of total liver perfusion measured by hepatosplenic radionuclide angiography.

In an attempt to establish whether repeated injection sclerotherapy (ST) has any influence on the portal venous fraction of hepatic blood flow, we investigated 8 patients with liver cirrhosis and esophageal varices immediately prior to and six months after ST, using computerized hepatosplenic radionuclide angiography. The mean values of the portal venous fraction of the hepatic blood flow before and after treatment did not differ (20 +/- SD 9% vs. 20 +/- 11%). Eight cirrhotics with esophageal varices who had received no ST served as controls. Also in these patients, the mean values did not change over a period of six months (17 +/- 10% vs. 17 +/- 14%). The mean portal venous fraction of hepatic blood flow was significantly higher (56 +/- 9%, p less than 0.001) in 10 subjects without hepatobiliary disease. The results show that while the portal venous fraction of hepatic blood flow is significantly reduced in patients with liver cirrhosis and esophageal varices, it is not influenced by ST.

Adult↗
PubMed1985

[Reconstruction of esophageal passage in functional disorders (achalasia, Zenker diverticulum, spasms)].

Before removing the diverticula (running suture for mucosa, interrupted stitches for the esophageal wall with resorbable material) a myotomy of the upper sphincter (pars inf. of the crycopharyngeal) muscle should be performed to restore the preoperative insufficient relaxation of the upper sphincter. The diffuse spasm shows a normal function of the LES; painful attacks can be treated by calcium antagonists or nitroglycerin. The achalasia can be treated either by endoscopic dilatation or myotomy to reduce the LES-pressure and restore the insufficient relaxation of the LES.

Dilatation↗
PubMed1985

Successful endoscopic transection of a partially obstructing antral diaphragm.

A 14-yr-old girl presented with long-standing symptoms of partial gastric outlet obstruction due to an antral mucosal diaphragm that had a central aperture of 4-5 mm. The literature of this congenital malformation is reviewed with respect to diagnostic criteria and feasibility of endoscopic transection. The procedure and outcome of this first successful endoscopic transection of a partially obstructing antral diaphragm are reported.

Adolescent↗
PubMed1985

Bacteriaemia associated with endoscopic sclerotherapy of oesophageal varices.

Studies on the incidence of bacteraemia following endoscopic injection sclerotherapy produce equivocal results. Accordingly, we performed a prospective study in 24 patients who underwent a total of 40 sclerotherapy sessions. Blood was drawn before, during, and 5 minutes, 30 minutes, 3 hours and 24 hours after sclerotherapy. Transient bacteraemia (mostly during and 5 minutes after sclerotherapy) was detected in 21 (53%) procedures. The bacteraemic events bore no relation to febrile episodes. The most frequently isolated microorganisms were alpha-haemolytic Streptococcus spp. and coagulase-negative Staphylococcus spp.. We conclude that injection sclerotherapy is associated with a high incidence of bacteraemia which, however, in most cases is transient and does not lead to septic disease.

Adult↗
PubMed1985

Long-term sclerotherapy of bleeding esophageal varices in patients with liver cirrhosis. An evaluation of mortality and rebleeding risk factors.

Ninety-six liver cirrhosis patients with bleeding esophageal varices receiving long-term sclerotherapy with the flexible endoscope were studied prospectively to analyze mortality and rebleeding risk factors. The difference in the 1-year survival rates of Child's groups A (100%) and B (82%) versus Child's C patients (38%) was highly significant (p less than 0.001). Multivariate analysis revealed that, as single factors, serum bilirubin, grade of ascites, and prothrombin time and, as a combination, the four variables bilirubin, ascites, aspartate aminotransferase, and age distinguished best between survivors and non-survivors during the first 6 months after inclusion in the study. For the separation of rebleeders and non-rebleeders during the first 2 months, prothrombin time and grade of ascites gave the best distinction. Thus, cirrhotics with variceal hemorrhage, ascites, jaundice, and a prolonged prothrombin time remain a high-risk group also with long-term sclerotherapy.

Adolescent↗
PubMed1985

[Liver perfusion scintigraphy: method, normal values and results of observations on the course of patients with esophageal varices].

In 26 patients, the hepatic perfusion index (HPI) was determined comparing the slopes of the arterial and portovenous part of hepatic perfusion curves. 10 patients without hepatobiliary disease served as normals. HPI was determined twice with a time interval of 6 months. In normals, HPI was significantly (p less than 0,001) higher (mean value: 56%) than in patients with liver cirrhosis (18%). Despite good "intra- and interobserver"-correlation (r = 0.96 and 0.92, respectively) large intraindividual variations make the detection of minor HPI changes impossible. However, the method permits a clear differentiation between normal and moderately to highly reduced portovenous liver blood flow.

Adult↗