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Biomedical subjects

B Kohler

Publications and source records attributed to B Kohler.

At least 37 records · Page 2Linked to original sources
PubMed1997

The use of electronic autoradiography in radiopharmacy.

The use of Microchannel Plate Analysers (Instant Imager, Canberra Packard), the so called Electronic Autoradiography, in Radiopharmacy is described. The system can be used for quality control of radiopharmaceuticals as well as for scientific research purposes. Quantitative analysis of 2-dimensional radioactive samples of all radionuclides used in Nuclear Medicine (especially 99mTc) can be performed in a very short time with little effort. Advantages and limitations for radiopharmaceutical work are described.

Autoradiography↗
PubMed1997

Acute ulcer bleeding. A prospective randomized trial to compare Doppler and Forrest classifications in endoscopic diagnosis and therapy.

The aim of our prospective randomized study involving 100 patients was to investigate whether Doppler ultrasound can be used to select patients at risk for ulcer rebleeding. Ulcers in the Forrest group classified as having a visible vessel or a clot were treated prophylactically by injection with epinephrine solution. In the Doppler group, in contrast, only ulcers with a positive Doppler signal were treated endoscopically. In the Doppler group, rebleeds occurred significantly less frequently (2%, P < 0.03) than in the Forrest group (14%). Emergency surgery was only necessary in the Forrest group (0% vs 5%; P = 0.02). Bleeding-related mortality was 0% and 4% (P = 0.15) and the overall mortality 0% and 10% (P = 0.02), in the Doppler and Forrest groups, respectively. These results appear to show that Doppler-based injection treatment is superior to endoscopic treatment based exclusively on the Forrest classification. In our study, Doppler-based local endoscopic treatment reduced the danger of a rebleed and thus the number of emergency operations and the overall mortality.

Acute Disease↗
PubMed1997

Reteplase (r-PA): a new plasminogen activator.

Reteplase (r-PA) is a genetically engineered deletion mutant of wild-type tissue-type plasminogen activator. The structural differences lead to different functional properties, such as a prolonged half-life. The compound demonstrated good thrombolytic efficacy in in vitro as well as in animal studies. In angiographically controlled patency studies (GRECO, GRECO-2 RAPID-1, RAPID-2), the double-bolus application scheme was established, and a superior patency profile for reteplase in comparison to alteplase was demonstrated. Mortality studies established reteplase as a safe drug with a 30-day mortality at least equivalent to streptokinase (INJECT) and very similar to alteplase (GUSTO-3). A possible advantage may be the double-bolus application without a need for weight adjustment, especially in a prehospital setting. Thus, reteplase can be regarded as an excellent alternative to streptokinase or alteplase for thrombolytic therapy in acute myocardial infarction.

Journal Article↗
PubMed1996

Using the SF-36 and Euroqol on an elderly population.

An important methodological issue in measuring health-related quality of life is whether instruments such as SF-36 and EQ can be used on an elderly population. This paper aims to test the completion, reliability and validity of the SF-36 and Euroqol on an elderly female population, and to compare them with the OPCS Disability Survey. Three hundred and eighty women aged 75 and over participated in a randomized controlled trial of the use of clodronate provided the sample. As part of the trial, patients were asked to complete the UK SF-36 and Euroqol, and the OPCS disability survey instrument administered by interview in a hospital clinic at baseline. A random subsample of respondents were retested six months later. The SF-36 achieved poorer levels of completion by dimension (68.1%-88.9%) than the OPCS (99.2%) and Euroqol (84%-93.5%) instruments. There were no major floor effects in the distribution of scores, except for the role dimensions of SF-36. Correlation between test-retest were significant for all instruments, but lower for the role dimensions and social functioning of SF-36, and these dimensions also had 95% Cls for the mean differences in excess of 10 points. There was substantial agreement between the three instruments, and evidence for their construct validity against age and recent use of health services. The sensitivities of the instruments were tested through hypothetical changes in health status. There was some evidence of greater sensitivity to lower levels of morbidity in the SF-36. Where brevity is required and the health changes are expected to be substantial, then EQ may be sufficient. For greater sensitivity SF-36 seems to have an advantage, however lower completion rates and problems with consistency suggest it requires adaptation. One solution would be to use interviewer administration. Another would be to change the SF-36 to make it more suitable for use in elderly people, although this may reduce its usefulness as a generic instrument.

Age Factors↗
PubMed1996

Idiopathic mesenteric varices causing lower gastrointestinal bleeding.

We report a case of lower gastrointestinal bleeding caused by idiopathic mesenteric varices. A 25-year-old man presented with a history of two episodes of lower gastrointestinal bleeding without transfusion. Colonoscopy revealed varices of the entire colon and terminal ileum. Intravariceal blood flow was demonstrated by dopplersonography. Vascular abnormalities were excluded by selective angiography of the upper and lower mesenteric artery. No therapy was given without a new episode of bleeding and there has been no further bleeding to date (a period of 14 months). Mesenteric varices are a rare cause of lower gastrointestinal bleeding, almost always associated with portal hypertension. The varices are idiopathic in only a few cases. The therapy depends on the intensity of bleeding, but resection is the most frequent treatment.

Adult↗
PubMed1996

Peroral laser lithotripsy of difficult intrahepatic and extrahepatic bile duct stones: laser effectiveness using an automatic stone-tissue discrimination system.

OBJECTIVES: The use of laser lithotripsy with an integrated stone-tissue discrimination system is an ambitious treatment modality for bile duct stone fragmentation. The aim of our prospective study was to determine the effectiveness and safety of the laser system and to find whether it reduced the need for choledochoscopy. METHODS: Thirty patients with complicated bile duct stones were treated perorally with a flashlamp-pulsed Rhodamine-6G dye laser and an automatic stone-tissue discrimination system. Initial treatment sessions were performed under fluoroscopic guidance in each patient and switched to choledochoscopic control if the stone could not be approached properly. RESULTS: Eighteen of 19 patients with extrahepatic bile stones were treated under fluoroscopic control; 17 of 19 patients were successfully treated through laser therapy. In nine of the patients with intrahepatic stones (n = 11), choledochoscopy was necessary for sufficient laser lithotripsy; seven of those patients became stone-free. Twenty-four of 30 patients (80%) were stone-free after sole laser therapy. Combined with other methods, the overall success rate was 27/30 (90%). Therapy-related mortality was 0%. CONCLUSIONS: Laser lithotripsy is effective and safe. The stone-tissue discrimination system facilitates therapy under fluoroscopic control and precludes the need for choledochoscopy, which is highly significant (p <0.001) if the calculi are extrahepatically located.

Adult↗
PubMed1996

-Bile duct stenoses and leakage after cholecystectomy: endoscopic diagnosis, therapy and treatment outcome-.

Minimal invasive methods compete with surgical treatment in the therapy of complications after cholecystectomy. In this retrospective study we evaluate the efficacy of endoscopically placed biliary stents in 35 patients (25 female, ten male) with biliary strictures and/or leakage after cholecystectomy. 27 patients received a 10- or 11.5-French endoprosthesis, eight patients needed a percutaneous-transhepatic-cholangio-drainage (PTCD). Four patients (11.4%) underwent a surgical therapy. Endoscopic therapy was successfully completed in 23 patients (65.7%), at which we noticed a superior result in patients with early incidenced stenosis/leakages after cholecstectomy. During a follow-up period of 1-109 months (median 28 months) two recurrent strictures (5.7%) were observed. As a complication we have seen a prosthesis-dislocation after PTCD. None of the patients died of complications related to endoscopic therapy.

Adult↗
PubMed1996

Endoscopic biliary stenting for the palliation of pancreatic cancer: results, survival predictive factors, and comparison of 10-French with 11.5-French gauge stents.

OBJECTIVES: To compare the efficacy and complications of different stent lengths and diameters in the palliation of jaundice caused by pancreatic cancer, as well as investigate survival predictive factors and the success of endoscopic therapy. METHODS: This study summarizes our results with 103 pancreas cancer patients treated by endoscopic plastic biliary stenting, of whom 87 were followed up until death or the time of writing. Before therapy, bilirubinemia, tumor primary size, presence of distant metastases, and signs of duodenal involvement were evaluated as prognosis risk factors. In a retrospective, nonrandomized fashion, we compared the efficacy and complications (especially clogging) of 10-French versus 11.5-French gauge stents and of "short" (< or = 8 cm) versus "long" (> or = 9 cm) prostheses. RESULTS: Thirty six men and 51 women (median age 74 yr) with pancreatic cancer were analyzed. Stenting could abolish jaundice or make it imperceptible (bilirubinemia < 3 mg %) in 74 patients (85%). Median bilirubinemia after treatment decreased from 13.9 mg/dl to 1.0 mg/dl. Hospital mortality was 2.7%. The commonest long term complication was clogging, which occurred 66 times in 33 patients. Median stent patency was 3 and 4 months for 10-F gauge and 11.5-F gauge stents, respectively (p > 0.05). When analyzing the patients who were alive 6 months after therapy, the clogging rate was 46% and 55% for 10-F and 11.5-F stents, respectively (p > 0.05). The length also did not influence stent patency. The only risk factor assessed before therapy, which independently predicted survival, was the presence of distant metastases. Median survival for patients with metastatic disease was 2.5 months and 9 months for those without metastases (p = 0.0015). CONCLUSIONS: We conclude that 10-F and 11.5-F stents have the same efficacy in the palliative management of malignant obstructive jaundice due to cancer of the pancreas. Detection of distant metastases is the best outcome predictive factor in these patients and should be regarded as a restriction to the insertion of biliary metal stents.

Adenocarcinoma↗
PubMed1996

[Aortoduodenal fistula as the cause of gastrointestinal hemorrhage].

The aortoenteric fistula is one of the rare causes of gastrointestinal bleeding. A 73 year old patient presented with a secondary fistula after implantation of a synthetic graft. The diagnosis was confirmed by endoscopy. At elective laparotomy, a communication between the graft and the duodenum was discovered. Principally the combination of gastrointestinal bleeding and aortic graft is always suspicious of an aortoenteric fistula. The treatment must be surgical.

Aged↗
PubMed1995

Clinical comparison of extracorporeal piezoelectric lithotripsy (EPL) and intracorporeal electrohydraulic lithotripsy (EHL) in difficult bile duct stones. A prospective randomized trial.

Today, nearly 90% of common bile duct stones are extracted endoscopically. Problems are encountered if there are large stones or a duct stenosis. Extracorporeal piezoelectric lithotripsy (EPL) as well as intracorporeal electrohydraulic lithotripsy (EHL) serve as an alternative to surgical intervention for those few patients in whom endoscopic measures have failed. A total of 35 patients with common bile duct stones in whom conventional endoscopic treatment had failed were selected on the condition that stone visualization through ultrasound was possible and that the papilla was within easy reach of the endoscope. Patients fulfilling the inclusion criteria were randomly treated either by EPL or EHL. The average age of our patients was 73 years. The main reasons for failure of conventional endoscopy were due to the large size of the stones (13 patients), impacted stones (16), or the presence of a biliary stricture (6). In the EPL group, visualization of the stones by ultrasound and ensuing treatment were possible in 16 of 18 patients (89%); stones could be fragmented in 15 patients. In 13 patients, the biliary tree could then be completely freed of calculi; the success rate was 72% for all the patients (13 of 18). On average, the patients had 2.3 treatments on the lithotripter, and 3870 shock waves were applied per treatment. In the EHL group stones were successfully fragmented in 13 of 17 patients (76.5%). The average number of treatments was 1.4. Comparing both therapies, there was no difference in stone-free rates. In both groups, additional endoscopic interventions were necessary to clear the bile duct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[Percutaneous transhepatic cholangioscopy (PTCS)--an important supplement in diagnosis and therapy of biliary tract diseases (indications, technique and results)].

In 39 patients with biliary disease inappropriate for a transpapillary access (21 m, 18 f, mean age 62 y.) 61 percutaneous transhepatic cholangioscopies (PTCS) were performed. In 28 cases (71.8%) diagnostic PTCS was done in order to investigate the etiology of a biliary stenosis. Nine of these patients had histological as well as clinical outcome indicating a benign lesion. Histology was positive for malignancy in 14 (82%) out of 17 patients with clinically assumed malignant stenosis. The etiology of the stenosis remained obscure from a clinical point of view in two cases with negative histology for malignancy. In twelve patients (30.7%) we performed PTCS for endoscopically controlled laser or electrohydraulic lithotripsy of bile duct stones. The procedure was successful in all patients and stone fragments were delivered to the duodenum by saline lavage. Seven of these patients had stones combined with a benign stenosis and were additionally treated by long-term drainage (Yamakawa drain) for three to twelve months. Two of the seven patients had no relaps of the biliary stricture after a follow-up of ten and twelve months respectively. In five cases (12.8%) PTCS controlled insertion of a guide-wire was attempted after failure of the radiologically guided internalization of the percutaneous drainage. The procedure was successful in three of these patients.

Adult↗
PubMed1995

[Anastomotic recurrence with tumor stenosis after Billroth II gastrectomy for adenocarcinoma: implantation of 2 metal stents as palliative therapy].

We report on a 70 year old patient with a great relapse in the region of the anastomosis after a palliative, subtotal gastrectomy with Billroth-II-gastrojejunostomie because of an adenocarcinoma one year before. He was unable to swallow fluids or solid food. The possibility of a sufficient gastroenteroanastomosis was certainly limited (great tumor-mass left during operation). So we implantated two metal stents in the afferent and the efferent limb, respectively. The patient's vomiting completely relieved and he was able to swallow fluid food again. After that treatment the patient's quality of live noticeably increased. Furthermore, by stenting the afferent limb a sufficient drainage out of the duodenum could be reached, thereby preventing an increasing cholestasis.

Adenocarcinoma, Mucinous↗
PubMed1995

[Bleeding peptic ulcers--concept for acute therapy].

Acute ulcer bleeding still is a life-threatening event. The therapeutic goal is to establish intensity, activity and location of the bleeding and to assess primary hemostasis by consequent endoscopic therapy, also preventing recurrence significantly. With the injection method, primary hemostasis accounts for over 90% success. Also recurrent bleeding can be stopped to the same extent. Endoscopic doppler allows a qualitative and quantitative registration of potentially dangerous vessels on the ulcer base. Drug therapy does serve for the acute treatment to a lesser extent; it is more valid for the initiation of the conservative ulcer therapy. Surgical interventions therefore confined to risk patients in whom a primary hemostasis failed or the ulcer is located in a dangerous site, for instance in the back wall of the duodenal bulb.

Acute Disease↗