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Biomedical subjects

W Swobodnik

Publications and source records attributed to W Swobodnik.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Gallstone treatment by electrohydraulic extracorporeal shockwave lithotripsy].

Extracorporeal shockwave lithotripsy (ESWL) with an electrohydraulic system was performed in 124 patients (33 men, 91 women; mean age 50.1 +/- 12.7 years). Sufficient stone fragmentation was achieved in 122 patients (98.3%). ESWL was repeated in 29 patients (23.3%), twice in 7 patients (5.6%). Average shockwave application per patient was 1,441 +/- 414 impulses, at a mean energy of 20.0 +/- 1.6 kV. Mean stone diameter before ESWL was 16.2 +/- 4.2 (7-30) mm, 7.1 +/- 4.1 (0-19) mm after ESWL. Computed tomography, performed immediately after ESWL in 88 patients demonstrated hypodense thickening (3-10 mm) of the gallbladder wall in 28.4% of patients. This was interpreted as wall oedema, reversible in all. One patient had a covered gallbladder rupture and two had biliary pancreatitis. None of the patients required emergency surgery. 93 patients (74.9%) had no stones 12 months later. A high success rate can be achieved if certain criteria are adhered to and suitable patients are selected.

Adult↗
PubMed1991

Fish oil, enriched with polyunsaturated fatty acids of the omega-3-type accelerates the nucleation time in healthy subjects.

The daily administration of fish oil, containing 1.5 g omega-3-fatty acids causes a significant decrease in nucleation time (12.1 +/-7.3 vs. 2.0 +/- 1.2 days, p less than 0.001), as well as in biliary cholesterol saturation and biliary cholesterol composition in 13 healthy subjects. The nucleation time, cholesterol saturation index and biliary lipids showed no significant differences in 11 cholesterol gallstone patients after a six-week treatment period with omega-3-fatty acids. Taurocholate percentage increased significantly in the gallstone group (10.4 +/- 3.9 vs 13.5 +/- 1.7%, p less than 0.05). The levels of the other bile acids remained unchanged during the treatment period. Therefore, the incidence of gallstones might be increased after treatment with fish oil, containing omega-3-fatty acids.

Adult↗
PubMed1991

Dissolution of bile duct stones by a hydrophilized glyceromonooctanoin-bile-acid-EDTA emulsion.

The clinical suitability of conventional glyceromonooctanoin (GMOC) and ethylenediaminetetraacetic acid (EDTA) containing solvents for the dissolution of common bile duct stones is questionable. To improve the solvent-stone contact and the miscibility with bile, GMOC was hydrophilized by the addition of polyethyleneglycol-caprylglyceride, polyethyleneglycol-sorbitan-etheroleyl-ester, and polyethyleneglycol-sorbitanlauryl-ester (PEG-GMOC). This product was mixed with a bile acid-EDTA (BA-EDTA) solution in a ratio of 1:2 (v/v) for cholesterol solubilizing and calcium complexing capacities. To determine clinical efficiency, the new solvent was infused via a nasobiliary tube in 16 patients with endoscopically nonextractable common bile duct stones and compared with a group of 16 patients treated with an alternating GMOC/BA-EDTA regimen. Continuous perfusion with PEG-GMOC-BA-EDTA led to a total (12 patients) or partial (3 patients) disappearance of the stones within 2-15 days. Similarly, alternating GMOC and BA-EDTA treatment dissolved the stones in 12 patients. The average volume of PEG-GMOC-BA-EDTA infused contained only 27% of the GMOC applied during the alternating therapeutic regime. This reduction of the GMOC dose was associated with a significant reduction of adverse effects such as emesis, diarrhea and biliary pain. We concluded that GMOC is equally efficient in the new hydrophilized form but it is clearly superior as far as side effects are concerned. In all, this supports its clinical suitability for the dissolution treatment of common bile duct stones.

Aged↗
PubMed1991

The quality of gastroenterological reports based on free text dictation: an evaluation in endoscopy and ultrasonography.

The majority of physicians consider the use of free dictation for medical reports to be essential in many domains. One of the main criticisms of structured data entry is the possible lack of flexibility and completeness. Electronic documentation systems exist for endoscopy and ultrasonography examinations which are based on structured input as well as on free dictation. Endoscopy and ultrasonography reports based on free dictation were evaluated for omissive errors. The data evaluated was drawn from a database of 18,239 gastroscopy and 3,340 colonoscopy reports dictated by 28 physicians over 74 months, and 18,834 ultrasonography reports dictated by 37 physicians over 42 months. The error rates varied from 0% to 41.8% depending upon the particular feature and the particular examination, but were usually below 15%. The results were independent of the experience of the examiner. This study provides baseline measurements of omissive error rates for selected findings in gastrointestinal endoscopy and abdominal ultrasonography which can be used as standards for the development and evaluation of systems for collection of clinical data.

Database Management Systems↗
PubMed1991

Diagnostic fine-needle puncture of the gallbladder with US guidance.

From February 1988 to January 1990, 118 fine-needle diagnostic punctures of the gallbladder (DPG) were performed under continuous ultrasound (US) guidance on symptomatic patients with gallstones. The first attempt at gallbladder puncture and aspiration was successful in every patient with use of a 22-gauge needle and continuous US visualization of the needle tip. The aspirated volume varied between 3 and 88 mL (average +/- standard deviation, 25.0 mL +/- 15.3). Biliary analysis revealed an elevation of the cholesterol saturation index in patients with cholesterol gallstones (attenuation at computed tomographic examination of 50 HU or less) relative to that in patients with pigment stones (attenuation more than 50 HU) (1.3 +/- 0.2 vs 1.0 +/- 0.1, P less than .05). The nucleation time was prolonged in patients with pigment stones (19.3 days +/- 3.5 vs 1.8 days +/- 0.8 for patients with cholesterol stones, P less than .001). All patients remained hospitalized for 24 hours after DPG and were reexamined on an outpatient basis at 1 and 3 months thereafter. No complications were detected during either short-term observation or long-term follow-up. The authors conclude that DPG is a safe and valuable technique in the diagnostic work-up of gallstone patients to establish their suitability for nonoperative treatment.

Adolescent↗
PubMed1991

Nucleation time, cholesterol saturation index, and biliary bile acid pattern. A comparison in responders and nonresponders to systemic litholysis with bile acids.

In a 24-month trial of a combination therapy with ursodeoxycholic acid and chenodeoxycholic acid complete dissolution of radiolucent gallstones was achieved in 15 of 55 patients (27.3%). A decrease of stone volume of greater than 35% was achieved in a further 28 patients (50.9%). In 12 patients (21.8%) inadequate compliance (3.6%), a nonfunctioning gallbladder (3.6%), absence of size decrease (10.9%), or acute cholecystitis (3.6%) required interruption of therapy. Determination of the cholesterol saturation index (CSI) did not facilitate patient selection, nor was there a statistically significant difference between responders and nonresponders to dissolution therapy. In the course of treatment the average CSI showed a statistically significant decrease from 1.54 +/- 0.12 to 0.82 +/- 0.06 (p less than 0.001). Patients in whom complete dissolution was achieved and those in whom no improvement was observed differed significantly in nucleation time (4.7 +/- 0.8 versus 15.0 +/- 2.2 days; p less than 0.001) and initial gallstone volume (274 +/- 78 versus 1045 +/- 180 mm3). The nucleation time increased statistically significantly during the therapy in the successfully treated group. The percentages of glycocholic acid (8.1 +/- 1.13 versus 4.1 +/- 0.55%; p less than 0.01), taurocholic acid (2.2 +/- 0.45 versus 0.8 +/- 0.23%; p less than 0.05), and glycodeoxycholic acid (4.9 +/- 0.70 versus 1.4 +/- 0.37%; p less than 0.001) were statistically significantly different after the treatment. There were no statistically significant differences between patients with complete and incomplete stone dissolution with regard to age, mean body weight, or laboratory variables.

Acute Disease↗
PubMed1991

Total biliary protein, mucus glycoproteins, cyclic-AMP, and apolipoproteins in the gallbladder bile of patients with cholesterol stones and stone-free controls.

The concentrations of total protein, mucus glycoprotein, cyclic-AMP, and apolipoproteins A-I, A-II, and B were determined in the gallbladder bile of patients with cholesterol gallbladder stones and in stone-free controls. The total protein content was significantly increased in gallstone patients (2.03 +/- 0.6 versus 1.31 +/- 0.67 mg/ml; p less than 0.05), as was the mucus glycoprotein concentration (380 +/- 88.5 versus 128 +/- 57.2 micrograms/ml; p less than 0.05). The cyclic-AMP concentration in the gallbladder fluid was increased up to 91 +/- 20 pmol/100 microliters in the gallstone subjects, as compared with 46 +/- 26 pmol/100 microliters (p less than 0.01) in stone-free controls. Cyclic-AMP concentrations correlated positively with the glycoprotein content of the bile in cholesterol gallstone patients (r = 0.66; p less than 0.05). The apolipoprotein concentrations were determined by the radial immundiffusion technique. The corresponding values for patients with stones and controls were 7.5 +/- 0.8 versus 3.0 +/- 0.8 for Apo A-I (p less than 0.025), 10.4 +/- 0.6 versus 6.3 +/- 1.3 for Apo A-II (p less than 0.02), and 1.9 +/- 0.5 versus 1.6 +/- 0.2 mg/dl for Apo B (NS), respectively. Biliary proteins probably play an important role in the nucleation process during the pathogenesis of cholesterol gallbladder stones.

Adult↗
PubMed1991

[Severe hyperemesis gravidarum--pathophysiologic observations and new therapeutic approach].

It is reported on a 27 year old female patient who was hospitalized twice during her first pregnancy (16th and 28th week) because of severe hyperemesis gravidarum. Severe clinical symptoms associated with severe alterations in the clinical chemistry posed a series of differential diagnoses. Several diseases as potential causes for unappeasable vomiting were taken into account. All traditional therapeutic efforts to relieve hyperemesis gravidarum including H2-blockers in high dosages were not successful. Treatment with omeprazole proved to be effective by stopping the vomiting immediately. After the delivery of a healthy child in the 37th week of pregnancy, several investigations were performed to exclude organic diseases. Etiology and symptoms of hyperemesis gravidarum are discussed with regard to the gastrointestinal tract and thyroid gland function.

Adult↗
PubMed1991

In vitro fragmentation of gallstones: comparison of electrohydraulic, electromagnetic and piezoelectric shockwave lithotripters.

To compare the fragmentation efficiency of three different shockwave systems, 63 human gallstone triplets were disintegrated in vitro using an electrohydraulic (MPL 9000, Dornier), an electromagnetic (Lithostar Plus, Siemens) and a piezoelectric (Piezolith 2300, R. Wolf) lithotripter. Since each stone triplet was obtained from the same gallbladder, the concrements of one such set were identical in physicochemical parameters. According to the maximal diameter, the calculi were divided into group A (6 to 15 mm) and group B (16 to 30 mm). Shockwave application was terminated when residual fragments measured 4 mm or less. Forty-five triplets were fragmented at energy settings mainly used in clinical treatment of patients with gallbladder stones (MPL 9000: 20 kV; Lithostar Plus: setting 9 (maximal); Piezolith 2300: setting 3). The fragmentation endpoint was achieved in group A (n = 3 x 36) with the Piezolith 2300 after median 150 (range = 50 to 500) pulses and with the Lithostar Plus after 150 (50 to 750) pulses compared with 500 (50 to 1,500) pulses using the MPL 9000 (p less than 0.01). In group B (n = 3 x 9) the Lithostar Plus (median = 750, range = 250 to 1,250 pluses) required fewer discharges than the Piezolith 2300 (1,250, 250 to 2,500 pulses; p less than 0.05) and the MPL (1,500, 500 to 1,600 [upper limit] pulses; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Cholelithiasis↗
PubMed1990

[Focal size and shock wave pressure: a comparison of three different physical shock wave generators].

Shock-wave delivery and focal size of three different generators-electrohydraulic, electromagnetic and piezoelectric--were compared. Pressure measurements were uniformly made by needle hydrophone (piezoelectric transducer). The smallest focus, 17 x 3 x 3 mm, was achieved with the piezoelectric system (50% isobars), while the focus with the electromagnetic generator was much larger (50 x 7 x 4 mm). With the electrohydraulic generator the focal size of the 60% isobars was 20 mm in the longitudinal axis. The highest pressure, 1512 bar, was achieved with the piezoelectric lithotriptor (mean shock-wave pressure in focus: electrohydraulic 1000 + 100, electromagnetic 1000 + 25, piezoelectric 1400 + 27 bar). The rapid positive pressure rise was followed by a slower pressure fall and a small negative wave. In the focal region the negative pressure wave was between 112 and 200 bar with the electrohydraulic system, 100-146 bar with the electromagnetic one, and 134 bar with the piezoelectric one. The significance of the negative wave is not clear; perhaps it contributes to the development of the cavitation effect and facilitates stone fragmentation.

Electromagnetic Phenomena↗
PubMed1990

Computed tomography evaluation of radiolucent gallstones in vivo.

Computed tomography facilitates an in vivo classification of gallstones and can aid in the identification of calcifications that escape detection with conventional radiologic procedures. Of patients with radiolucent stones, 54.8% exhibited calcifications either in the form of discrete rims (41.9%) or at the center of the stone (12.9%). Densities of the noncalcified areas of partially calcified stones averaged 40.68 +/- 6.8 Hounsfield units (HU), which was not significantly higher than the average of 31.85 +/- 3.19 HU for noncalcified stones. Calcified regions showed significantly higher densities (240.0 +/- 28.6 HU, p less than 0.001, x +/- SEM). Of the identified stones, 16.1% showed densities greater than 50 HU. These were primarily bilirubin stones, which cannot yet be treated successfully with conservative therapeutic modalities.

Adult↗
PubMed1990

[Ultrasound criteria of a meniscus lesion].

The tear in the meniscus interrupts the outline at which the sound-wave energy is reflected. This means that the sonogram shows an echo-rich, light reflection pattern. Degeneration also shows up as an echo-rich area, reflecting greater density of the tissue in the meniscus. This has been confirmed by experimental examination of knees of corpses, and also by clinical experience based on more than 2000 sonograms of the meniscus. A quota of more than 90% correct diagnoses can be obtained if the proper criteria are observed in case of a lesion of the meniscus, and if the technical equipment is adequate and the examiner has acquired sufficient skill.

Diagnosis, Differential↗
PubMed1990

[Ultrasound evaluation of gallbladder function using planimetry].

Fourteen patients with gallstones (13 female, 1 male; mean age 45.1 +/- 14.6 years; mean body weight 105.7% +/- 18.7% of ideal body weight) were included in the present study. Prior to and 45 min. after administration of a standard fatty meal, patients were examined by ultrasound. The mean gallbladder volume decreased from 20.94 +/- 10.0 cm3 to 6.83 +/- 3.5 cm3 (ejection fraction (EF) = 61.7 +/- 27.9%), the mean cross-sectional area from 12.0 +/- 3.4 cm2 to 6.0 +/- 2.8 cm2 (percentage changes 48.0% +/- 25.5%). A correlation is shown to exist between the ejection fraction of gallbladder emptying and the decrease of gallbladder area (r = 0.91; p less than 0.001). The simple measurement of the gallbladder area of a section through the long axis adequately demonstrates gallbladder contraction.

Adult↗
PubMed1990

[Comparison of ultrasound-controlled fine needle and coarse needle puncture of defined lesions in the abdomen].

Within a 2-year period 677 diagnostic fine needle (DFP) and coarse needle punctures (DGP) were performed in 536 patients. In 34 patients (14 women; 20 men; 54 +/- 17.6 years) the abdominal tumour mass was punctured with the fine needle (22 g) as well as with the coarse (18 g) needle. Sensitivity of DGP accounted for 72%, sensitivity of DFP was 82.6%. Specificity was 100%, respectively. Complications could not be observed, neither with the coarse needle nor with the fine needle. Due to the high sensitivity of DFP this method should be employed first in the diagnostic work up of abdominal tumours.

Abdominal Neoplasms↗
PubMed1990

[Morphological changes in the gallbladder after extracorporeal shock-wave lithotripsy].

The present study reports on 51 patients with symptomatic cholecystolithiasis, who accordingly underwent extracorporeal shock-wave lithotripsy (ESWL). In all cases, computed tomography (CT) was performed prior to and after the therapeutic procedure to delineate changes in gall-bladder morphology. Slight edematous thickening of the gall-bladder wall was found in 15 patients. One patient presented a rupture of the gall-bladder with formation of a bilioma in the adjacent liver tissue. In case of calcific concrements, CT revealed a characteristic pattern of fragment distribution following shock-wave treatment, and fragments of various sizes exhibited distinct adhesion to the gall-bladder wall.

Adolescent↗
PubMed1990

[Percutaneous transhepatic lysis of gallstones].

The present study reports on morphological findings obtained from 15 patients who were submitted to percutaneous transhepatic contact dissolution of gallbladder concrements with methyl-tert.-butyl ether (MTBE) and--in case of slightly calcified gallstones (n = 10)--with ethylene diamine tetraacetic acid (EDTA). At a maximum intracystic catheter placement time of four days complete lysis was obtained in 12 patients. As could be depicted by CT, the solvents induced significant regional or disseminated chemical cholecystitis in the majority of all cases. However, these changes proved to be completely reversible within about five weeks. It is concluded that with certain types of gallstones contact dissolution can be an effective alternative therapeutic technique which, however, requires meticulous morphological controlling in view of the time-consuming treatment of calcified concrements.

Adult↗