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Biomedical subjects

B C Manegold

Publications and source records attributed to B C Manegold.

At least 19 recordsLinked to original sources

[An interesting case--endoscopic hemostasis of an actively bleeding sigmoid diverticulum--a case report].

A pulsating arterial bleeding from a diverticulum, situated in the colon sigmoideum, was identified and stopped during video-documentation in a 70 year-old man. After injection with a solution of suprarenin, the diverticulum was turned out like a balloon into the colon and didn't show any signs of further bleeding until the patient was prepared for a semi-elective resection of the sigmoid. This case demonstrates that emergency endoscopy is an effective method for diagnosis and even therapy of massive lower intestinal bleeding which eventually has to be supplemented by radiological techniques like scintigraphy and arteriography.

Aged

[Esophageal perforation in attempted ERCP].

In this report we refer to a 88-years old female patient who was admitted to our hospital under the diagnosis of cholecysto- and choledocholithiasis. Due to clinical symptoms, general performance status and sonographically proven dilated bile ducts emergency-ERCP was performed by an experienced endoscopist. Unfortunately esophageal perforation occurred due to subsequently diagnosed hiatus hernia. Potential pitfalls during examination as well as a concept of problem management during endoscopies with side-view optics will be discussed.

Aged

Extracorporeal shock-wave lithotripsy and endoscopy: combined therapy for problematic bile duct stones.

Endoscopic treatment of bile duct stones is currently successful in 86% of patients. We prospectively studied the efficacy and complication rate of extracorporeal shock-wave lithotripsy (ESWL) of problematic bile duct stones combined with endoscopy. When stone removal was not possible, patients were subjected to ESWL. Fragmented stones were removed endoscopically. During 1 year, 220 patients presenting with choledocholithiasis were diagnosed and 188 were successfully treated endoscopically. In all, 3 subjects received alternative treatment and the remaining 29 (13%) constituted our study group; 19 (65%) were women and the mean age was 76.7 years. Overall, 22 (76%) were high-risk patients; 23 (79%) were jaundiced and 9 (31%) had cholangitis at admission. The most frequent indication for ESWL was stone size. Stone fragmentation was achieved in 80% of cases. Complications were mild and were managed conservatively. No patient died. Complete stone clearance was possible in 23 (80%) cases. The association of ESWL and endoscopy enhanced the success rate of endoscopic stone clearance from 86% to 96%. During the same period, open surgery was performed in 4 cases for residual common bile duct (CBD) stones and in 32 cases in association with simultaneous cholecystectomy.

Aged

Long-term results of palliative endoscopic and surgical intubation of benign oesophageal stenoses.

Benign oesophageal stenosis can be treated by different methods. Besides surgical procedures and established conservative treatment (e.g. dilatation), more invasive endoscopic techniques such as cryosurgery and laser therapy have recently been developed. Intubation, which has been used to treat malignant strictures, can also be used in benign oesophageal strictures. Between 1977 and 1989 a total of 43 tubes were implanted in 26 patients (mean age 62.3 years). The mean duration of intubation was 149 days. We report our experience in patients intubated for (1) acid burns, (2) actinic strictures, (3) peptic strictures, (4) postoperative stenosis, (5) postoperative complications and (6) tracheo-oesophageal fistulae. We also discuss the complications (dislocation, disintegration, bleeding, perforation, operative removal) and long-term results. Because of the prolonged survival of patients with benign oesophageal stenosis, follow-up and late complications are of particular importance in this report. Despite drawbacks, intubation is an option in the management of patients with benign oesophageal stenosis.

Adult

Endovision 534.

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Endoscopes

[Endoscopic and surgical therapy of malignant colorectal polyps].

87 malignant colorectal polyps were removed in 81 patients by endoscopic polypectomy from 1972 until 1987. Thereafter 34 of these patients had a surgical resection of the colon. Surgical resection was performed for incomplete excision of the polyp (20 x), for tumor invasion of the lymphics in the polyp stalk and for moderately/poor differentiated carcinoma. In 6 patients a residual carcinoma was detected in the removed colon specimen, but lymph-node metastasis only in one with moderate-differentiated carcinoma. Our results demonstrate that colorectal polyps with invasive well-differentiated carcinoma and tumor free base do not need a surgical resection. Patients of the high-risk-group (moderately/poor-differentiated carcinoma, invasion of blood vessels and lymphatics, incomplete excision), should be referred to further surgical resection. With regard to the low rate of metastatic spread even in patients with high-risk-polyps accurate differentiation seems to be necessary. In 19 out of 52 (36.5%) patients endoscopic control examinations after surgical or endoscopic resection revealed recurrent pathological findings. On the base of the presented data we conclude that there is a need for short-term endoscopic controls over a period of five years.

Adenocarcinoma

[Therapy of stomach ulcer with sucralfate and ranitidine. A multicenter double-blind study].

134 outpatients with acute benign gastric ulcer confirmed by endoscopic biopsy received either 1 g sucralfate suspension four times daily or one 150 mg ranitidine tablet twice daily for six to 12 weeks in a multicentre therapy study (double-blind study according to the double-dummy technique). After six to 12 weeks, respectively, 56% and 82% of the ulcers had healed in the sucralfate group. The rates of healing in the ranitidine group were 72% and 88%, respectively. The differences in the rates of healing between sucralfate and ranitidine were not statistically significant. Ranitidine was superior to the sucralfate suspension in corpus ulcer. In the distally located ulcers, the two kinds of treatment were equivalent. There were no appreciable differences between the medications with regard to antacid consumption and compliance. Gastric pain was influenced better by ranitidine than by sucralfate.

Antacids

[New aspects of early gastric carcinoma].

Between 1st January 1970 and 31st December 1984, 910 total or subtotal resections for gastric cancer were carried out in the Department of Surgery of the University Clinic Mannheim. A work-up of operative specimens showed that 146 patients (16%) had early gastric carcinoma. The patients comprised 97 men and 49 women; the youngest was 31, the oldest 86 years. The following trends were apparent when the 58 patients operated on between 1970 and 1976 were compared with the 68 patients operated on between 1977 and 1982: An increase in early gastric carcinoma is also detectable in younger patients. The previously seen tendency for localisation in the antrum appears to have changed in favour of the upper segments of the stomach. The proportion of the diffuse type rose from 26% in the first group to 44% in the second. The 5-year survival of all patients with early gastric carcinoma was 78.8%. No significant difference could be found between the diffuse and intestinal type. The prognosis of early gastric carcinoma appears to be dependent on the depth of invasion and involvement of the lymph nodes.

Adenocarcinoma

[Congenital dilatations and stenoses of the bile ducts in children (author's transl)].

The congenital choledochus cyst is an extremely rare disease pattern. The author presents two own cases of boys aged 4 1/2 years in whom the disease was manifested as a fusiform dilatation of the cholodochus and of the other bile ducts on the one hand, and by a cyst in the second case. Both cases were characterised by an additional annular stenosis of the cholodochus immediately before the junction of the pancreatic duct. The article discusses the most essential criteria in respect of clinic, diagnosis and therapy, as well as the etiological aspects.

Bile Ducts