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Biomedical subjects

T Schmitt

Publications and source records attributed to T Schmitt.

At least 37 records · Page 2Linked to original sources
PubMed2000

Retroperitoneal endoscopic debridement for infected peripancreatic necrosis.

Standard management of infected peripancreatic necrosis consists of open surgical debridement and lavage--a traumatic intervention with substantial morbidity and mortality. As an alternative and novel approach with minimum invasiveness, we present fenestration of the gastric wall and debridement of infected necrosis by direct retroperitoneal endoscopy. In three patients, this strategy led to rapid clinical improvement and no serious complications. Transgastric endoscopic therapy may be a less traumatic alternative to surgery and should be further assessed in prospective studies.

Acute Disease↗
PubMed2000

Manometrically-guided endoscopic injection of botulinum toxin for esophageal achalasia: a pilot trial.

AIMS: Some patients gained only short-term response (< 6 months) after botulinum toxin (BTX) injection for achalasia. This may be due to an incorrect site of injection when targeting the lower esophageal sphincter by using endoscopic landmarks only. PATIENTS AND METHODS: 7 elderly patients (4 females, 67 +/- 20 years) with classical achalasia received manometrically-guided botulinum toxin injection by means of a double-channel endoscope. Thereafter, they were clinically re-evaluated at 6 weeks and later on at bi-monthly intervals. RESULTS: The mean symptom score decreased 6 weeks after the manometrically-guided BTX-treatment from 12 +/- 2 (before BTX) to 6 +/- 2 points (p = 0.02). However, according to the study criteria one patient did not respond to BTX-injection and underwent subsequent cardiomyotomy. The LES-resting pressure was found not to be altered in this patient (6 weeks after BTX-injection) but manometry revealed a marked decrease of the LES-tone in 3 other patients who benefitted from BTX-injection. 5 of the 6 patients, who initially benefited from BTX-injection, relapsed 10 months (range, 6-13 months) after their initial BTX-treatment. They all were treated with repeated BTX-injections. At completion of the study (1.5-year follow-up) the mean symptom score of the 6 patients was still significantly lower (6 +/- 2 points) than before study entry (p = 0.03). CONCLUSION: Manometrically-guided endoscopic BTX-injection is a simple, safe and highly effective (during 1.5-year follow-up) technique for treatment of esophageal achalasia. With the manometrically-guided injection technique one may obtain a longer lasting symptomatic response than with the traditional method of BTX-application.

Adult↗
PubMed2000

[Local injection of depot corticosteroids in endoscopic therapy of benign bile duct strictures].

BACKGROUND: Local injection of depot-corticosteroids into benign esophageal strictures has been proven to maintain the effects of bougienage or balloon dilation. METHODS: Eight consecutive patients with benign common bile duct (CBD)-strictures (postoperative, n = 6, primary-sclerosing cholangitis, n = 2) were enrolled in this pilot trial. All had undergone initial balloon dilation and insertion of a 10F-plastic prostheses without relevant effects on the stricture diameter four to six weeks before. Than all patients underwent another balloon dilation and insertion of a 10F-Tannenbaum-stent. In the same session injection of 2 x 10 mg of triamcinolone (Volon A, Bristol-Myers Squibb, München) into the CBD-wall at the stricture site by means of a sclerotherapy needle was performed. Four to six weeks later ERC was repeated and balloon dilation and/or stent exchange was performed whenever indicated. RESULTS: The initial mean diameter of the CBD-stenoses was 1.81 +/- 0.65 mm. The mean serum levels of the alkaline phosphatase (AP) and of bilirubin were 455 +/- 188 U/L and 4.9 +/- 2.2 mg/dl, respectively. After the initial balloon dilation and stent insertion no significant improvement had been registered (1.9 +/- 0.7 mm). However, after local triamcinolone injection and the second dilation/stent insertion the diameter of the CBD-stenosis increased significantly to 3.68 +/- 0.96 mm (p < 0.01). No adverse affects were recognized. Three patients had complete recovery of their CBD-stenosis after a third dilation, the remaining five patients were cured after two or three additional balloon dilations with intermittent stent exchange. Thereafter, no recurrence of a CBD-stenosis was observed during a median follow-up of twelve months. At completion of the study the mean serum AP- and bilirubin level were 195 +/- 87 U/L and 1.2 +/- 0.4 mg/dl, respectively. CONCLUSION: Local application of depot corticosteroids is a feasible and safe procedure for therapy of benign CBD-stenoses. The results of this pilot trial justify a randomized study.

Adult↗
PubMed2000

Endoscopic sphincter of Oddi manometry with a portable electronic microtransducer system: comparison with the perfusion manometry method and routine clinical application.

BACKGROUND AND STUDY AIMS: Endoscopic perfusion manometry (PM) of the sphincter of Oddi (SO) requires expensive equipment which is relatively large and uncomfortable to handle in the endoscopic retrograde cholangiopancreatography (ERCP) setting. Furthermore, the volume load of the biliopancreatic system may contribute to the increased risk of pancreatitis after SO manometry. PATIENTS AND METHODS: The newly developed small and lightweight microtransducer system consists of a portable data-logger with integrated online display which is connected to a 4-Fr manometry probe. The manometry catheter is inserted endoscopically into the biliopancreatic system via a 7-Fr Teflon sheath. SO motility can be observed online on the display but the data can also be stored for later analysis on a personal computer (PC). To validate the new method, 15 patients with suspected biliary SO dysfunction underwent both PM as well as microtransducer manometry (MTM) in randomized order. Thereafter, 50 consecutive patients with suspected biliary or pancreatic SO dysfunction were investigated solely by MTM. RESULTS: PM was possible in 13 of 15 cases whereas MTM could be performed in all 15 patients. The basal SO pressure tended to be lower (approximately 5 mmHg) when measured with the MTM, compared with the PM method, but there was a significant and nearly linear correlation between the basal SO pressures obtained by both methods (r=0.98, P<0.001). SO dysfunction was diagnosed in the same five patients using both methods. Furthermore, the parameters of phasic SO motility were highly comparable when measured by MTM and PM. MTM was carried out successfully in 49 of 50 patients and only one MTM probe was used for all examinations, without malfunction. The endoscopist was able to diagnose SO dysfunction (by immediate observation of SO motility on the display) in 19 of 20 patients (when compared with the later PC analysis) and SO motility was judged correctly as normal in the remaining 29 cases. MTM was repeated in five patients with SOD 1-6 weeks after the first examination and the manometric findings were confirmed in all cases. Mild postmanometry pancreatitis was observed in only one of 49 patients (2%). CONCLUSIONS: Endoscopic MTM is a reliable, safe, very easy to handle, and low-cost alternative for the clinical assessment of SO motility.

Adult↗
PubMed2000

Endoscopic ultrasound-guided one-step transmural drainage of cystic abdominal lesions with a large-channel echo endoscope.

BACKGROUND AND STUDY AIMS: Transmual endoscopic drainage of peripancreatic fluid collections under endoscopic ultrasound (EUS) control has been reported. We evaluated a facilitated technique of one-step puncture and drainage using a new stenting device and a large-channel echo endoscope. PATIENTS AND METHODS: EUS-guided transumural drainage of cystic lesions was attempted in six male patients. The drainage sites were duodenal in two instances and gastric in four. The lesions were pseudocysts, arising from chronic pancreatitis (n=2), and following acute pancreatitis (n=3), and one abscess. The median size of the pseudocysts was 50mm (range, 25 to 90). The punctures were carried out under direct EUS guidance, using a new echo endoscope with a 3.2-mm working channel. Transmural drainage was done using modified 7-F stents. Stents were inserted directly over a 1-mm puncture needle and their position was optimized using a 7-F pusher connected to the stent by a special construction. The stents were released by withdrawing the needle. RESULTS: EUS-guided one-step drainage was technically successful in all 6 patients. It was possible to position the stents as desired, regardless of the location, size or pathogenesis of the target lesions. There were no complications associated with the endoscopic interventions. All the lesions, including two with putrid contents, had collapsed by the day following drainage. The stents were removed after a median period of 2 weeks (range 2-12). The cysts had completely resolved in four patients at follow-ups of 3-13 months (range). The patient with the gastric abscess underwent gastrectomy 2 weeks after stent extraction, because of a coincidental adenocarcinoma at the cardia, the abscess being resolved. One patient with necrotizing pancreatitis, who refused surgical treatment, died because of septic complications. CONCLUSIONS: New large-channel echo endoscopes allow more aggressive endoscopic interventions to be carried out safely under direct EUS control. One-step drainage using the new 7-F stent-over-needle device was effective for six cystic lesions of variable origin.

Adult↗
PubMed2000

[Complications of radiotherapy in patients with age-related macular degeneration (AMD). A study of 48 cases].

PURPOSE: This study describes the ocular complications after teletherapy indicated for patients with age-related macular degeneration (AMD). MATERIAL: and methods: The study concerned 48 patients suffering from an exudative form of age-related macular degeneration, non suitable for laser photocoagulation, and irradiated by high-energy electron beam therapy. RESULTS: With a mean follow-up time of 2 years, late effects were observed in 16 (33. 3%) patients: 9 (18.75%) radiation optic neuropathies, 9 radiation retinopathies (18.75%) and 2 neovascular glaucomas (4.1%). CONCLUSION: The frequent and serious complications observed led us to adapt the technique and dose of radiation therapy indicated in patients with age-related macular degeneration.

Aged↗
PubMed1999

[Extracorporeal shockwave lithotripsy in cholecystolithiasis using a new type of minilithotripter].

BACKGROUND AND OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) of gallstones has until now required fixed, nearly room-sized and expensive equipment. It has become even less cost-effective with an increase in the number of laparoscopic cholecystectomies. The authors have technically modified a mini-lithotripter, used for dissolving salivary stones, for application against gallstones (by changing the energy spectrum and depth of focus). PATIENTS AND METHODS: 125 consecutive patients with solitary gallstone underwent lithotripsy according to a standard protocol (including oral litholysis), 64 of them (average age 42.5 +/- 9.3 years; 44 women, 20 men) by conventional ESWL (with the Modulith), 62 (average age 41.6 +/- 10.1 years; 43 women, 13 men) with a modified mini-lithotripter (Minilith). Clinical and sonographic follow-up took place at 1, 3, 6 and 12 months. Quality of life was documented according to a point score (GIQL), developed specially for patients with gastrointestinal conditions. RESULTS: The mini-lithotripter applied significantly lower voltage and more shock-wave impulses per treatment than the conventional ESWL (p < 0.01), while patient tolerance, measured with a visual analogue scale, was the same. Application of the mini-lithotripter was easier and quicker than with conventional ESWL, namely 31 +/- 8 min vs 41 +/- 12 min (p < 0.01). Frequency of adequate stone fragmentation per patient was the same for both methods, 2.2 +/- 0.5 applications with the mini-lithotripter vs 1.6 +/- 0.3 with conventional ESWL (p < 0.01). There was no significant difference between the methods with regard to improved quality of life (increase of GIQL scale of 16% with the conventional ESWL, 14% with the mini-lithotripter) or freedom from stone at 1 year after lithotripsy (conventional ESWL: 80%, mini-lithotripter: 82%). Colics recurred in 15 of 64 patients receiving conventional ESWL, and in 13 of 61 in the mini-lithotripter group (difference not significant). There were no other complications. CONCLUSION: The cheaper mini-lithotripter, costing only a third of the conventional ESWL, is equally effective in the dissolution of gallstones.

Adult↗
PubMed1999

The Lateral suppressor (Ls) gene of tomato encodes a new member of the VHIID protein family.

The ability of the shoot apical meristem to multiply and distribute its meristematic potential through the formation of axillary meristems is essential for the diversity of forms and growth habits of higher plants. In the lateral suppressor mutant of tomato the initiation of axillary meristems is prevented, thus offering the unique opportunity to study the molecular mechanisms underlying this important function of the shoot apical meristem. We report here the isolation of the Lateral suppressor gene by positional cloning and show that the mutant phenotype is caused by a complete loss of function of a new member of the VHIID family of plant regulatory proteins.

Amino Acid Sequence↗
PubMed1999

Phase II study of a radiotherapy/etoposide combination for patients with newly malignant gliomas.

PURPOSE: Etoposide, a semisynthetic derivative of podophyllotoxine, is a topoisomerase II inhibitor. This drug is currently used in several types of human cancer. The aim of this study was to evaluate the efficacity and tolerance of a near-concurrent association of radiotherapy and etoposide for newly malignant gliomas. METHODS: From May 1995 to December 1996, 30 malignant glioma patients were included in this phase II study; 16 patients underwent surgical tumor resection, and a stereotactic biopsy was performed in 14 patients. Standard cranial irradiation and six courses of etoposide (100 mg/m2, x days 1-3) were administered. The first course of etoposide was administered on days 1-3 of radiotherapy and was resumed in the week following the end of radiotherapy. Treatment was consolidated by further courses of etoposide every 4 weeks. RESULTS: Only 26 patients could be evaluated for the purpose of our study. The median age was 60.1 years, and the median Karnofsky performance score (KPS) was 80.2. The rate of objective response for evaluable patients was 34.6%, and four complete responses (CR) and five partial responses (PR) were noted. The median survival (MST) was 12 months, and the average overall survival was 12.5 months. Hematological toxicity was mild, and grade 3 or 4 neutropenia (white blood cell count < 1500/ml) was noted in three patients, without any sepsis or bleeding. CONCLUSIONS: The results obtained in this study are comparable to the best reported results on the combination of radiotherapy and nitrosoureas. The near-concurrent combination of radiotherapy and etoposide seems to be effective and well tolerated in the treatment of newly malignant gliomas.

Adult↗
PubMed1999

Endoscopic botulinum toxin injection into the minor papilla for treatment of idiopathic recurrent pancreatitis in patients with pancreas divisum.

BACKGROUND: In some patients with pancreas divisum, obstruction to the flow of pancreatic juice into the duodenum is the presumptive cause of acute recurrent pancreatitis. However, identification of those patients who may benefit from minor papilla sphincterotomy or stent placement is difficult. METHODS: Five patients with acute recurrent pancreatitis and pancreas divisum were therefore treated by endoscopic injection of 50 units of botulinum toxin into the minor papilla in an outpatient setting. RESULTS: Botulinum toxin injection was successfully performed on six occasions in 5 patients and no adverse effects were noted. Two patients relapsed after 9 and 10 months, respectively, but had definite relief of symptoms after needle-knife sphincterotomy. One patient relapsed 7 months after botulinum toxin injection but became symptom free again after a second botulinum toxin injection. Another patient is still in clinical remission 4 months after botulinum toxin administration, and 1 patient did not respond to either botulinum toxin administration or to sphincterotomy and stent placement. CONCLUSIONS: Endoscopic injection of botulinum toxin into the minor papilla in patients with pancreas divisum and acute recurrent pancreatitis is a safe procedure that is easy to perform and provides short-term relief in some patients. Response to botulinum toxin injection may predict whether patients with pancreas divisum and acute recurrent pancreatitis will benefit from other forms of endoscopic therapy.

Acute Disease↗
PubMed1999

Complications and adverse effects of colonoscopy with selective sedation.

BACKGROUND: Cardiopulmonary adverse effects are commonly observed in patients undergoing colonoscopy with sedation. This study determines the incidence of such events when sedation is given only when required. METHODS: In 2500 consecutive patients, colonoscopies were started without premedication but sedation was offered if significant discomfort occurred. Parameters of blood pressure, heart rate, oxygen saturation and patient appearance were continuously recorded by a nurse assistant. Additional adverse effects occurring during or after the procedure were noted in the patients' protocol. Risk factors for the development of complications were evaluated with the use of a logistic regression model and the odds ratio. RESULTS: Ninety-five percent of all patients required neither sedation nor analgesia. Adverse effects occurred in 59 patients (2. 4%). Twenty-six of these patients (1.0%) had short-lasting episodes of oxygen desaturation and 22 patients (0.9%) experienced vasovagal reactions. Mechanical complications occurred in a total of 8 patients (0.3%) and consisted of 2 perforations and 6 episodes of hemorrhage. In the logistic regression model, impaired physical status was the single most important risk factor for the development of cardiopulmonary complications (odds ratio 4.7; 95% confidence interval [2.0, 11.4]). CONCLUSIONS: In experienced hands, patients undergoing colonoscopy rarely require sedation. If selective sedation is used, cardiopulmonary adverse effects occur in approximately 2% of all patients, most of whom require no medical intervention.

Aged↗
PubMed1999

Non-unity molecular heritability demonstrated by continuous evolution in vitro.

INTRODUCTION: When catalytic RNA is evolved in vitro, the molecule's chemical reactivity is usually the desired selection target. Sometimes the phenotype of a particular RNA molecule cannot be unambiguously determined from its genotype, however. This can occur if a nucleotide sequence can adopt multiple folded states, an example of non-unity heritability (i.e. one genotype gives rise to more than one phenotype). In these cases, more rounds of selection are required to achieve a phenotypic shift. We tested the influence of non-unity heritability at the molecular level by selecting for variants of a ligase ribozyme via continuous evolution. RESULTS: During 20 bursts of continuous evolution of a 152-nucleotide ligase ribozyme in which the Mg2+ concentration was periodically lowered, a nine-error variant of the starting 'wild-type' molecule became dominant in the last eight bursts. This variant appears to be more active than the wild type. Kinetic analyses of the mutant suggest that it may not possess a higher first-order catalytic rate constant, however. Examination of the multiple RNA conformations present under the continuous evolution conditions suggests that the mutant is superior to the wild type because it is less likely to misfold into inactive conformers. CONCLUSIONS: The evolution of genotypes that are more likely to exhibit a particular phenotype is an epiphenomenon usually ascribed only to complex living systems. We show that this can occur at the molecular level, demonstrating that in vitro systems may have more life-like characteristics than previously thought, and providing additional support for an RNA world.

Base Sequence↗
PubMed1999

[Propofol sedation in endoscopic manometry of Oddi's sphincter].

Endoscopic manometry of the sphincter Oddi (SO) is a sophisticated method which requires a cooperative patient. Therefore, during endoscopic manometry sufficient i.v. sedation is crucial, and additionally must no affect SO-motility. In a pilot trial SO-motility was determined in ten patients with suspected SO-dysfunction (SOD) under initial sedation with 4.8 +/- 1 mg midazolam (baseline), and 3 min after an i.v. bolus of 50 mg of propofol. In addition, endoscopic manometry was performed in 57 consecutive patients with suspected SOD from 10/94-9/95 under sedation with midazolam (6.2 +/- 1.6 mg), and from 10/95-9/96 with propofol (268 +/- 111 mg). Sedation was always performed by an independent physician according to a standardized protocol. Neither the SO-baseline pressure nor the parameters of phasic SO-motility were significantly altered by propofol (including two patients with proven SOD). Propofol causes a more rapid onset of sedation, and the time interval to obtain successful biliary cannulation was shorter than under midazolam (p < 0.05). Successful manometric recordings could be obtained in 82% of the patients under midazolam but in 96% of the patients under propofol-sedation (p < 0.05), respectively. The patient cooperation was significantly better rated (by the endoscopist) in the propofol group than in the midazolam group (p < 0.01). The blood pressure and the heart rate were not significantly affected in both groups, however, propofol caused a significant decrease of the oxygen saturation (p < 0.05). Accordingly, an apnea episode had to be mastered by mask ventilation via ambu bag in one patient under propofol-sedation (uneventful recovery). In the midazolam group flumazenil-administration was necessary in four patients. The post-procedure recovery was faster after propofol--than after midazolam-sedation (p < 0.05). In conclusion, propofol is suitable for i.v. sedation during endoscopic manometry of the spincter of Oddi.

Adult↗
PubMed1999

[A new papillotome for cannulation, pre-cut or conventional papillotomy].

UNLABELLED: A new papillotome was designed to overcome certain drawbacks of the needle-knife, that is most commonly used for precut sphincterotomies. The intention was to develop an instrument at least as good as the needle-knife or the Erlangen-type precut papillotome for precut procedures. In addition, it had to be suitable for direct cannulation of the biliary or pancreatic duct. PATIENTS AND METHODS: According to a prospective protocol 54 patients in whom a papillotomy was indicated were examined with the new instrument. The protocol allowed three futile attempts to cannulate or two inadvertant cannulations of the pancreatic duct with a standard cannula and hydrophilic guide wire before a precut was performed. The new baby-papillotome has a diameter of only 1 mm and a short 10 mm cutting wire. Similar to a guide wire it is introduced via a 6F- or 7F-introducer catheter. RESULTS: Cannulation of the desired duct (the bile duct in 48 patients, the pancreatic duct in five patients, Billroth II anatomy in three patients) was successful within one session in 98% (53/54). In one patient, the bile duct was successfully cannulated in a second session using the baby-papillotome, resulting in an overall success rate of 100%. Primary cannulation using the new papillotome without precut was obtained in 24% (13/54). Complications were mild pancreatitis in one patient and nonsignificant bleeding in three (immediate endoscopic hemostasis in all, no transfusions, no drop of hematocrit). There were no serious complications. CONCLUSION: The new baby-papillotome is suitable for precut as well as for primary cannulation. In this first series, the desired duct was cannulated in 98% within the first session with a low complication rate. Further studies of the new instrument seem desirable.

Catheterization↗
PubMed1998

Technetium-99m sestamibi brain single-photon emission tomography for detection of recurrent gliomas after radiation therapy.

Technetium-99m sestamibi (MIBI), an alternative radiopharmaceutical for myocardial perfusion imaging, has also been proposed for use as an imaging agent for various tumours, including breast cancer, lung cancer, lymphomas, melanomas and brain tumours. After routine radiation therapy, deteriorating clinical status or treatment failure may be due to either radiation-induced changes or recurrent tumour. Computed tomography and magnetic resonance imaging offer imperfect discrimination of tumour viability and radionecrosis. Against this background we undertook a retrospective study of 35 malignant glioma patients in whom clinical deterioration had occurred, in order to clarify the value of 99mTc-MIBI SPET in identifying tumour recurrence. SPET was performed 15 min after intravenous injection of 1110 MBq with a dual-headed gamma camera using a fan-beam collimator. Transverse, coronal and sagittal views were reconstructed. Intense MIBI uptake was found in 31 patients. This uptake was correlated with tumour recurrence as proved by histology and/or rapid, fatal evolution of these cases. The statistical analysis performed on this population of patients with MIBI uptake revealed a group of patients with a long mean survival and a group with a short mean survival. Two subgroups were found within each of these groups, according to the functional index ratio (tumour uptake/pituitary gland uptake ratio). No MIBI uptake was found in four patients who are still alive and can be considered to be disease-free. In those cases showing MIBI uptake, death occurred an average of 6.69 months following brain SPET. According to our results, the specificity and sensitivity of 99mTc-MIBI brain SPET seem to be high. Moreover, this technique is more accurate than computed tomography or magnetic resonance imaging for discriminating between tumour recurrence and radionecrosis.

Adult↗
PubMed1998

Aggressive treatment with complete remission in primary diffuse leptomeningeal gliomatosis--a case report.

Primary leptomeningeal gliomatosis is rare, and the diffuse form (PLDG) is even more unusual. The following report is an example. A 17 year-old man developed a syndrome characterized by extensive basal and chronic spinal meningitis. Routine biological tests showed elevated levels of CSF proteins, and moderate mononuclear pleocytosis, with no direct evidence of neoplasia, leading to a diagnosis of chronic meningitis. A second meningeal biopsy, guided by MRI and performed in the left frontal region, led to the specific diagnosis of primary diffuse leptomeningeal gliomatosis. Treatment including ventricular and lumbar shunting, a course of cortico-spinal radiation, and three courses of an eight-drug systemic chemotherapy with intrathecal methotrexate lead to complete remission over 15 months. We believe that this is the first report of such a remission in the literature.

Adolescent↗