Biomedical subjects

B Münster

Publications and source records attributed to B Münster.

15 recordsLinked to original sources

PubMed1994

Cystic dilatation of the common bile duct: surgical treatment and long-term results.

Twelve patients (11 female) with an extrahepatic biliary cyst (six type I, three type II and three type III according to the classification of Todani) are reviewed with emphasis on aetiology, clinical features and long-term results at follow-up of 3-10 years. The clinical manifestations were abdominal pain, cholestasis with jaundice, fever and episodes of pancreatitis. The diagnosis was established before surgery in all cases by ultrasonography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and computed tomography. An abnormally long common channel was found in four patients. Three patients had had cysts drained internally in the 1970s. Of these three patients, one developed carcinoma of the cyst 23 years later. Radical excision of the dilated bile duct and reconstruction by Roux-en-Y hepaticojejunostomy was performed in nine cases. Two patients, each with a small choledochocele, were treated successfully by endoscopic sphincterotomy and stone extraction. There were no serious postoperative complications. All nine patients operated on remained in good health for 3-10 years. These results support radical excision of the cystically dilated bile duct with reconstruction by end-to-side Roux-en-Y hepaticojejunostomy for types I and II cyst. Endoscopic treatment of type III choledochocele should be limited to the management of smaller lesions.

Adolescent↗

PubMed1991

[Diagnosis and surgical therapy in congenital ectasias of the intra- and extrahepatic bile ducts].

31 patients with congenital ectasias of extra- and intrahepatic bile ducts have been diagnosed and treated between 1980 and 1991 at the Charité. 7 ectasias belonged to type I, two to type II, three to type III, four to type IV and fifteen to type V of classification by Alonso-Lej/Todani. The age of affection was between 8 and 80 years. Symptoms are not specified and directed to affection of liver or bile ducts. Main symptoms of type I--III were complaints in the upper abdomen and jaundice, of type IV--especially after previous surgery--fever and also jaundice. Complaints in the upper abdomen and fever dominated in type V. The right diagnosis succeeds at 27 out of 31 patients with direct cholangiography. Sonography and computerized tomography were not always in a position to attach the clinical picture to congenital ectasias. In extrahepatic ectasias is the resection of bile duct cysts--carried out in 2/3 of all cases--the therapy of choice. Once was found a carcinoma in a resected bile duct cyst 23 years after a choledochocysto-jejunostomy. By Caroli syndrome the therapy must be fixed individually. 6 patients were supplied operative (liver resection, choledochotomy, papillotomy, extraction of lithiasis). Instrumentally were carried out 9 endoscopic papillotomies with extraction of concrements and 6 lay ins of internal drainage catheters were done.

Adolescent↗

PubMed1991

[Anomaly of the pancreatico-biliary junction and etiology of choledochal cysts].

The etiology of choledochal cysts isn't yet clarified unequivocably. Numerous theories have been worked out. One of them is the 1969 by Babbitt postulated "common-channel"-theory, which is based on an anomaly of the pancreaticobiliary connection. In case of a fusion of ductus choledochus and ductus pancreaticus widely before the papilla of Vater and the formation of a common channel with a minimum length of 15 mm the reflux of pancreatic secretion into the off-leading biliary ducts may occur and choledochal cysts may develop. In order to check up this hypothesis we evaluated retrospectively pictures of a direct cholangiography (ERCP, PTC and/or intraoperative cholangiography) of 26 patients suffering from type I, IV and V ectasias of the biliary ducts according to Todani. We found a common channel with an abnormal length in 8 of 12 patients suffering from extrahepatic ectasias of the biliary duct type I and IV (66%), but we didn't find it in patients with type V intrahepatic ectasias of the biliary duct. This analysis may be recognized as a reference to the truth of the Babbitt-theory.

Cholangiography↗

PubMed1989

[Endoscopic-radiologic diagnosis and therapy of the bile ducts. Results of endoscopic papillotomy].

Endoscopic-radiologic methods for demonstrating the hepatobiliary and pancreatic ducts are an integrated part of the diagnostic spectrum of gastroenterologic centers. At the Charité since 1975 we have made more than 5,500 endoscopic-retrograde cholangio-pancreaticographies (ERCP's). This method provides immediately or later an adequate therapy as an alternative to the otherwise necessary surgery. The most frequently used and basic method is endoscopic papillotomy (EPT). In most cases it precedes endoscopic removal of concrements, prosthetic drainage of biliary pathways or extracorporal shockwave lithotripsy (ESWL). Since 1977 we have carried out 2,050 EPT's at the Charité, more than 60% of these for patients of higher age (above 60). With 98.3% successful interventions complications were seen in only 4.7% of the cases. The influence of close interdisciplinary cooperation of endoscopicists and radiologists on the results of the investigation and the rate of complications is discussed.

Adult↗

PubMed1989

[Changing trends in percutaneous and endoscopic bile duct drainage].

Analysis of 1,104 non-surgical biliary drainages (600 ERCD, 531 PTCD) from 1983 to 1988 concerning changing frequency, indications and success rates. With a continuous increase of the total numbers, the fraction of percutaneous-transhepatic drainages has decreased to 28%. With increasing degree of difficulty and risk PTCD (90.9% success) is indicated primarily in case of impossible ERCD (85.9% success) and hilar benign and malign biliary obstruction for temporary or permanent biliary drainage. Both methods are complementary and are increasingly used for combined palliative drainage.

Adolescent↗

PubMed1987

[Conservative bile duct drainage].

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Catheters, Indwelling↗

PubMed1983

[The significance of pulmonary artery angiography in the early postoperative phase following unilateral homologous lung transplantation].

In animal experiments there was carried out the homologous left-sided lung transplantation in quest of possibilities in therapy of the respiratory failure. Postoperative angiographies of the pulmonary artery took place in general anesthesia in 14 operated dogs to disclose vascular changes in the transplant at the early postoperative phase qualified by operation and rejection. The evaluation of the anastomosis of the pulmonary artery succeeded very well whereas the assertation about the venous anastomoses remains uncertain. A lengthening of the hemodynamic time phases by rejection was intimated previously in the early postoperative phase; statistical significance existed, however, only for the first venous filling. Furtheron, the perception of vascular morphological changes is possible in more distant advanced rejection processes. The angiography of the pulmonary artery in connection with the chest X-ray film and scintigraphic methods is of great importance for the evaluation of the transplant function especially for complications which result from the vascular system of the transplant.

Animals↗

PubMed1983