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Biomedical subjects

A Rambow

Publications and source records attributed to A Rambow.

At least 19 recordsLinked to original sources
PubMed1991

[Extrasystoles during extracorporeal biliary shockwave lithotripsy. Their incidence and clinical significance].

Incidence and clinical significance of cardiac side effects of extracorporeal shock-wave lithotripsy (ESWL) were prospectively analysed for 85 patients (26 men, 59 women; mean age 44 [17-81] years) with cholecystolithiasis (n = 70) or choledocholithiasis (n = 15). 24-hour ECG monitoring was undertaken on the day of treatment. Additionally, during ESWL cardiac rhythm and blood pressure were monitored. ESWL was performed with an electromagnetic lithotriptor under light anaesthesia with intravenous diazepam (10 mg) and pethidine (75-100 mg). There were no superventricular premature systoles in any of the patients during treatment. In 15 patients with occasional ventricular premature systoles (VPS) (6-81 per 23 hours) in the 24-hour ECG the number of VPS increased during the one-hour ESWL procedure significantly to 6-55 (P less than 0.05). 14 of these patients had an unremarkable cardiac history. Changing the lithotriptor coupling angle failed to suppress the VPS in only two patients. In these two it was necessary to trigger the shock wave with the ECG. Blood pressure rose markedly (up to 220 mm Hg systolic) during ESWL in only three patients, known hypertensives. But this rise was easily controlled with nifedipine, 10 mg sublingually. These data demonstrate that ESWL is a safe alternative to operative treatment, even in the presence of existing cardiac disease. Nonetheless, precautions should be taken in case there are complications.

Adolescent↗
PubMed1991

Investigation of the effect of duodenoscopy on sphincter of Oddi manometry.

To investigate whether endoscopy affects sphincter of Oddi (SO) manometry, three patients who had undergone previous cholecystectomy and had a T-tube in situ for drainage were studied. Manometry was performed using a perfused triple lumen manometry catheter (diameter 1.7 mm), which was advanced into the SO lumen through the T-tube. SO motility, baseline pressure, common bile duct pressure and duodenal pressure were monitored before and during endoscopy while the tip of the endoscope was in the mouth, esophagus (upper third, precardial), stomach and duodenum. Endoscopy and even a moderate insufflation of air necessary to pass the pylorus and inspect the papilla of Vater did not affect the parameters mentioned. Thus, ERCP manometry is a reliable method for evaluation of SO motility which is not affected by endoscopy. Duodenal pressure is a stable parameter and suitable for serving as reference pressure.

Adult↗
PubMed1991

[Lymphographic findings in AIDS patients].

The lymphographic findings in 20 patients with AIDS-most in clinical stage IV-can be divided into four categories. In six there were no specific changes and in a further six the storage pattern was that of sinus histiocytosis. One patient showed transition to malignant lymphoma and another patient had atypical mycobacterial infection of the retroperitoneal lymph nodes. Six patients showed a lymphographic pattern of scarring. The results of this study show that lymphography is a sensitive method that can provide important additional information.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Electromagnetically generated extracorporeal shock wave lithotripsy and adjuvant combined oral litholysis for therapy of symptomatic gallbladder stones.

A prospective study was conducted to evaluate effectivity, problems and adverse effects of extracorporeal shock wave lithotripsy (ESWL) using a newly developed electromagnetic biliary lithotriptor (Lithostar Plus, Siemens, Erlangen, FRG) for the treatment of selected patients presenting with symptomatic cholecystolithiasis. In addition to generally accepted criteria for the selection of patients, gallbladder contractility was established and pigment stones were excluded by computed tomography (CT). 80 out of 486 patients (63 females, 17 males, mean age 36, range 17-76 years) were selected for ESWL using a standardized diagnostic program. 62 out of 80 patients participating in the study had solitary concrements (diameter 23.3 +/- 6.4 mm) while in 18 patients 2 or 3 stones (diameter below 10 mm) were observed. Stone fragmentation was achieved after an average of 1.35 treatment sessions (range 1-3) in 78 (97.5%) patients. No clinically relevant adverse effects were observed. Immediately after ESWL, ultrasound revealed misleading results with regard to stone fragmentation. 98.7% of patients (n = 77) were seen for follow-up investigations 3, 6 and 9 months after ESWL, and 82% at 12 months. A total of 40 (53%) patients became free of stones. Subgroup analysis showed that 68% of the patients were free of stones (stone diameter 10-20 mm), 54% (20-30 mm) and 33% (multiple stones), respectively. We therefore conclude that ESWL should be restricted to highly selected patients presenting with small (10-20 mm) solitary concrements.

Administration, Oral↗
PubMed1991

[Computerized tomography differentiation of pigment and cholesterol bile duct calculi].

Successful oral litholytic and other non-operative therapies of gallstones require exact determination of the stone components. Since computed tomography (CT) provides highly sensitive measurement of density, we performed a study to evaluate whether CT measurement of stone density allows to predict the composition of radiolucent gallstones. 28 patients presenting with 29 radiolucent gallbladder (n = 17) or common bile duct stones (n = 12) were included. Prior to operative or endoscopic therapy the attenuation values (Hounsfield Units/HU) were assessed in vivo by CT under standardised conditions (Somatom II; 125 KV; 130 mAs). After surgical or endoscopic stone removal the concrements were dehydrated, homogenised and then analysed by infrared spectroscopy. 18 cholesterol and 11 pigment stones could be identified. The attenuation values (Hounsfield Units) of cholesterol stones amounting to 28-98 HU (48.7 +/- 4.4 HU) differed significantly (p less than 0.001) from pigment stones (90-120 HU/105.5 +/- 2.8 HU). We conclude that computed tomography provides exact discrimination between cholesterol and pigment stones in vivo. Since only cholesterol stones can be dissolved by cheno/ursodeoxycholic acid we recommend to measure the radiodensity of gallstones by CT prior to any litholytic therapy.

Bile Pigments↗
PubMed1990

[Esophageal varices: is bleeding predictable?].

Hemorrhage of oesophageal varices is still a life-threatening complication of portal hypertension. Parameters to identify patients being on risk to bleed are on demand for prophylactic therapy. Recent studies showed that bleeders present with larger varices, red color sign of the variceal wall and higher intravariceal hydrostatic pressure than patients without previous hemorrhage. Advanced liver disease (Child C) is an additional risk factor. The clinical value of the parameters appears to be decreased by a significant overlap of the findings obtained in bleeders and non-bleeders. However, patients with small varices, low variceal pressure (less than 12 mmHg) and fair condition are considered to be not on risk to bleed from varices. An additional clinical value of the parameters is provided by the potency to define patients more accurately for future clinical studies.

Esophageal and Gastric Varices↗
PubMed1990

[Retractile mesenteritis. Diagnostic and therapeutic aspects].

An 18-year-old boy, who had severe abdominal pain for 18 months associated with marked weight loss, was found to have a stenosed ileal sling on double-contrast radiology of the small intestine. At operation a plate-like tumour was extending from the pancreas to the aortic bifurcation. Histological examination of removed tissue revealed retractile mesenteritis (mesenteric panniculitis; liposclerotic mesenteritis). The symptoms regressed and the patient again gained weight under immunotherapy with 1 mg/kg of prednisone and 2 mg/kg of cyclophosphamide daily. Subsequently, under prednisone alone, there was a recurrence, which responded within five weeks to daily 60 mg prednisone and 125 mg cyclophosphamide. The patient remains symptom-free on 125 mg cyclophosphamide and 10 mg prednisone daily.

Abdominal Pain↗
PubMed1990

Analysis of radiolucent gallstones by computed tomography for in vivo estimation of stone components.

Successful oral litholytic and other nonoperative therapies of gallstones require exact determination of the stone components. Since computed tomography (CT) provides highly sensitive measurement of density, we performed a study to evaluate whether CT measurement of stone density allows a prediction of the composition of radiolucent gallstones. Twenty-eight patients presenting with 29 radiolucent gallbladder (n = 17) or common bile duct stones (n = 12) were included. Prior to operative or endoscopic therapy the attenuation values (Hounsfield Units, HU) were assessed in vivo by CT under standardized conditions (Somatom II, 125 KV, 130 mAs). After surgical or endoscopic stone removal the concrements were dehydrated, homogenized and then analysed by infra-red spectroscopy. The previously measured Hounsfield units were not known to the investigator. Eighteen cholesterol and 11 pigment stones could be identified. The attenuation values (Hounsfield units) of cholesterol stones amounting to 28-98 HU (48.7 +/- 4.4 HU) differed significantly (P less than 0.001) from pigment stones (90-120 HU/105.5 +/- 2.8 HU). We conclude that computed tomography provides exact discrimination between cholesterol and non-cholesterol stones in vivo. Since only cholesterol stones can be dissolved by cheno- and ursodeoxycholic acid we recommend measurement of the radiodensity of gallstones by CT prior to any litholytic therapy. Furthermore the prediction of the stone composition facilitates the decision on extracorporeal shock wave lithotripsy and the selection of specific solvents for contact lysis via a nasobiliary probe.

Bilirubin↗
PubMed1990

Electromagnetically generated extracorporeal shockwaves for fragmentation of extra-and intrahepatic bile duct stones: indications, success and problems during a 15 months clinical experience.

Electromagnetically generated extracorporeal shock waves (without waterbath) were applied after intravenous premedication with 10-15 mg diazepam and 100 mg tramadol in the treatment of 33 patients (aged 32 to 91 years) with multiple intrahepatic stones (n = 4) or huge common bile duct stones (n = 29, 18-30 mm in diameter), which could not be removed by conventional endoscopy. Stone disintegration was achieved in 70% of common bile duct stones and in all intrahepatic concrements after 800-7500 discharges, which were applied during one (n = 21), two (n = 6) or three sessions (n = 6). Apart from mild fleabite-like petechiae at the side of shock wave transmission no other side effects were observed for a total of 51 procedures. We believe electromagnetically generated shock waves are safe, easy to apply, and relatively effective in the therapy of common bile duct and intrahepatic stones.

Adult↗
PubMed1989

[Extracorporeal shockwave lithotripsy of gallstones: how many patients are suitable for it?].

The proportion of patients with gallbladder stones suitable for extracorporeal shockwave lithotripsy (ESWL) was analysed prospectively in 200 patients aged 17-76 years (62 males, 138 females) with symptomatic cholecystolithiasis. Criteria for inclusion were clinical symptoms, solitary stones (diameter 10-30 mm) or up to three stones with comparable total volume, contractile gallbladder, no calcification of stones, normal biliary tract anatomy. To check these criteria a step-by-step diagnostic procedure was instituted which consisted of history, ultrasonography with contractility test, abdominal X-ray film, computed tomography measurement of stone density, and endoscopic retrograde cholangiography. Only 19 patients fulfilled the criteria. The others had to be excluded because of history (35), stone size or number (73), impaired gallbladder contractility (27), calcified stone (30), pigment content (12), and/or biliary tract anatomy. Thus only a surprisingly small percentage (about 10%) of patients with symptomatic gallbladder stones is suitable for ESWL.

Adolescent↗
PubMed1989

[Duplex sonography of the portal vein. Procedure in healthy probands and patients with portal hypertension].

Duplex ultrasonography is a useful non-invasive means of investigating portal vein blood flow in cases of liver disease. A group of 50 selected consecutive patients with portal hypertension revealed a significant increase in portal vein diameter of 3.5 mm on average, and a significant decrease in mean flow rate of, on average, 3.1 cm/s, in comparison with a group of 50 healthy control subjects. In contrast, alcohol-induced portal hypertension appeared always to be associated with an elevated flow rate. On average, the flow volume increased by 200 ml/min. With the exception of vessel diameter, which remains virtually unchanged, both patients and controls revealed, postprandially, a comparable increase in the parameters measured.

Blood Flow Velocity↗
PubMed1989

Electromagnetically generated extracorporeal shock waves for gallstone lithotripsy: in vitro experiments and clinical relevance.

First generation shock wave sources have been proved to disintegrate gallstones effectively, but they require the immersion of the patient's body in a tank of water. A recently developed second generation shock wave source (Siemens-Lithostar, Erlangen, FRG) generates shock waves electromagnetically. It presents several novel features. In particular the waterbath can be omitted and due to lower shock wave pressure general anaesthesia is not required. In vitro studies showed that 36 out of 38 gallstones (11-30 mm in diameter) could be disintegrated. Two concrements resisting lithotripsy were pure white cholesterol stones. Independent of shape, size, and composition (cholesterol or pigment) the maximum diameter of remaining fragments after lithotripsy was between 1 and 8 mm. For sufficient disintegration precise focusing (+/- 1 cm) of the stones and maximum power of the shock wave generator were required.

Cholelithiasis↗
PubMed1988

Contrast media for ERCP.

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Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1988

[ERCP: which contrast medium is suitable?].

To evaluate, wether a new non-ionic contrast medium decreases the complication rate of endoscopic retrograde cholangiopancreaticography (ERCP), we performed a prospective randomized study in 46 indoor patients with suspected pancreatic or bile duct related disease. The low-osmolar low-viscosity non-ionic Iopromid (Ultravist, n = 15), the low-viscosity high-osmolar Ioglicinate (Rayvist, n = 18), and the conventional dissociable high-viscosity Ioxaglinate (Heaxbrix, n = 13), each presenting a iodine content of 300-320 mg/ml were compared. All three contrast solutions gave excellent imaging of pancreatic and bile ducts. No complications, particularly no pancreatitis were observed. Hexabrix caused significant elevations of gamma-GT from 126 U/l to 178 U/l and mof lipase from 144 U/l to 418 U/l (p less than 0.01), respectively. Following Rayvist or Ultravist injections, no significant changes of the leucocytes, SGOT, SGPT, gamma-GT, AP, lipase and amylase were observed. We conclude that ERCP performed by skilled investigators is a low risk procedure. Selection of suitable contrast media may diminish hepatotoxic and pancreatotoxic side effects. According to our results, we recommend low-viscosity contrast media (Rayvist, Ultravist). The presumed benefit of the non-ionic solution (Ultravist) could not be demonstrated.

Adult↗