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Biomedical subjects

C Ell

Publications and source records attributed to C Ell.

At least 163 records · Page 9Linked to original sources
PubMed1994

Coated and uncoated self-expanding metal stents for malignant stenosis in the upper GI tract: preliminary clinical experiences with Wallstents.

OBJECTIVES: The clinical feasibility of self-expanding metal stents with respect to the technical success, complications, and reintervention rate should be tested. METHODS: Five coated and 26 uncoated prototype Wallstents, especially designed for stenosis of the upper GI tract, were implanted in 23 patients. All patients with dysphagia suffered from inoperable tumor stenosis of the esophagus or the cardia. Stent implantation was performed under slight i.v. sedoanalgesia. RESULTS: Technical success was achieved in all 31 implanted stents. Forty-eight hr after implantation, dysphagia was improved in 21/23 patients. Acute problems observed within 1 wk were stent migration (1 patient, uncoated stent), oblique position of the stent (3 patients), epigastric or retrosternal pain (9 patients), insufficient stent expansion (4 patients), and pouch formation at the upper rim of the stent (4 patients). An uncomplicated follow-up (median 66 days, range 10-139 days) was seen in 12 patients (52%). Major problems in the follow-up period were stent migration in three patients (three coated stents, two stent migrations in one patient) and stent obstruction by tumor ingrowth/overgrowth and/or food impaction in eight patients (35%). Most of these problems could be successfully resolved by implantation of a second stent or electrocoagulation of overgrowing tumor tissue. By the 1st of March, 1994, three patients were still alive with a follow-up period of 530 days (median range, 336-880 days); 20 patients were decreased with a follow-up period of 70 days (median range, 3-374 days). CONCLUSIONS: Implantation of esophageal Wallstents is safe and has a low risk of acute complications and mortality for the patient. Early complications such as perforation and bleeding did not occur. Tumor ingrowth/overgrowth are the major reasons for the high reintervention rate in the follow-up period. Coated stents can resolve this problem, provided that stent migration can be avoided by improvement of the coating technology.

Adenocarcinoma↗
PubMed1994

[Radiation burden in diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP)].

UNLABELLED: The increasing expansion of diagnostic and, in particular, of therapeutic ERCP calls for greater consideration of the radiation dose to which the investigator and assistant personal are exposed and emphasizes the question of additional radiation protection measures such as leadshielded glasses and thyroid protection. MATERIALS AND METHODS: Local radiation doses were measured in 19 ERCP sessions at head level of the endoscopist, assistant staff and the radiologist, respectively. The fluoroscopic time, the area dose product (ADP) and the measuring height were recorded. A quotient based on the measured local dose and the ADP was formed which includes all variables having an effect on the scattered radiation. Using this quotient and the known ADP-values radiation exposure levels were mapped over a period of three months and then extrapolated to obtain the annual dose. RESULTS: Not only the FT, but also the ADP, the measuring height, and the source-image-distance (SID) are found to influence the magnitude of the radiation dose to which the investigator and his assistants are exposed at head level. For an assumed rate of 1200 ERCPs per year a median radiation at head level of 16.5 mSv/a is calculated for the investigator, and a corresponding head-level dose of 5.5 mSv/a for the assistants. This shows that the eye dose to which the investigator (and his assistants) are exposed amounts to 10% (5%) and the thyroid dose to 5% (1.5%) of the legally prescribed limit dose. If fewer ERCPs are performed, or if the investigations are divided up among several doctors and assistants, radiation exposure is reduced accordingly. CONCLUSIONS: Under the prevailing investigation conditions additional radiation protection measures such as leadshielded safety glasses or thyroid protection do not appear necessary.

Body Burden↗
PubMed1994

Piezoelectric shock wave lithotripsy of pancreatic duct stones.

OBJECTIVES: The efficacy of extracorporeal piezoelectric shock wave lithotripsy in patients with obstructing pancreatic duct stones was investigated. METHODS: Fifty patients suffering from chronic pancreatitis and obstructing pancreatolithiasis were treated by ESWL (Piezolith 2500). Shock wave treatment was administered, inasmuch as the stones were not extractable by initially applied endoscopic measures. RESULTS: A total of 119 (2.4 +/- 1.4, range 1-7) lithotripsy sessions were conducted; only mild sedation/analgesia was used. Optimum targeting of the concrements in the shock wave focus was achieved in 17 (14%) treatment sessions with ultrasonography only; it was achieved in 65 (55%) cases by fluoroscopy and, in further 37 (31%) sessions by using both localization systems. Stone fragmentation was successful in 43 (86%) patients. Nineteen (38%) patients achieved spontaneous stone discharge after shock wave lithotripsy. In 11 (22%) cases, it was possible to remove all fragments endoscopically; residual fragments remained in 20 (40%) patients. Severe complications attributable to shock wave application did not occur. During follow-up, six patients had to be referred to surgery; two male patients died of specific diabetic complications and pleural mesothelioma, respectively. Thirty-five (90%) of 39 patients whose conditions were followed for 2-50 (20 +/- 14) months reported improvement of their pain sensations. Six (15%) patients required endoscopic treatment, including ESWL in five of those patients, to be repeated due to recurrent formation of calculi in the main pancreatic duct, which was again successful in five of the six patients. CONCLUSIONS: Piezoelectric shock wave lithotripsy offers a basis for safe and effective fragmentation of pancreatic stones and facilitates endoscopic procedures. Most of the patients with obstructing pancreatic stones became stonefree and showed a significant reduction of pain.

Calculi↗
PubMed1993

[Liver hemangiomatosis in Osler's disease].

Heart failure occurred in a 50-year-old woman as a result of calcified haemangiomatosis of the liver with a high shunt volume. In the subsequent years there were several bleedings from peptic ulcers. Ultrasonography revealed an increase in liver size and the previously diagnosed calcification. 14 years later the patient was again hospitalized because of increasing weakness and stress dyspnoea; the haemoglobin level was 5.5 g/dl. In addition to the florid gastric and duodenal ulcers, angiodysplasias were for the first time demonstrated in the stomach, duodenum and sigmoid colon, as were telangiectasias in the face and echo-dense round foci in the spleen. After transfusion of red cell concentrates and healing of the peptic ulcers under a 14-day treatment with omeprazole (20 mg two times daily by mouth) and amoxycillin (750 mg three times daily by mouth) the haemoglobin level increased at first (10 g/dl), then tarry stools were once again noted. The condition stabilized after laser coagulation of all accessible gastrointestinal angiodysplasias. The isolated calcified hepatic haemangiomatosis, diagnosed 14 years previously, is most likely a rare variant of hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu disease).

Calcinosis↗
PubMed1993

[Endoscopic therapy of biliary pancreatitis].

Gallstones are the most important causes of acute pancreatitis. Endoscopic-retrograde cholangiography (ERC) is indicated in all situations of acute pancreatitis where the cholestatic enzymes are elevated, the common bile duct is dilated or stones or sludge are detected in the gallbladder sonographically. Additional indications are cholecystectomized patients and where there is no evidence of heavy alcohol ingestion. If common bile duct stones are detected by ERC, endoscopic sphincterotomy is the treatment of choice. In severe cases of biliary pancreatitis in particular, endoscopic therapy improves the final outcome and reduces morbidity and mortality rates. The more severe the clinical situation, the earlier endoscopic therapy should be performed.

Acute Disease↗
PubMed1993

New bougie applicator system for intraluminal "high dose rate" afterloading radiotherapy of esophageal carcinoma.

Applicators used to date in endoluminal "high dose rate" (HDR) afterloading (AL) radiotherapy of esophageal carcinoma consist of hollow plastic probes with an average thickness of 4 mm (1.8-5.0 mm), the diameter of which, however, often strongly deviates from that of the lumen of the tumor stenosis. Consequently, the probe can occupy an eccentric position in the esophagus. Exact dosimetry in the tumor region thus becomes virtually impossible, since the dose of the iridium emitter drops significantly with increasing distance (> 60% at a distance of 5 mm from the surface of the 4 mm probe). The bougie-type afterloading applicators developed by our group, however, offer a number of distinct advantages in comparison to conventional applicator probes: 1. Precise positioning of the applicator in the stenosis with simultaneous bougie effect. 2. Exact centering of the radiation source in the lumen of the esophagus. 3. Individual adaptation of the applicator size to the diameter of the residual lumen resulting from the tumor. 4. Upon patient-specific adaptation of the radiation exposure period, a distinct reduction of the surface (mucosa) dose is achieved together with simultaneous enhancement of the depth effect of radiotherapy treatment. Using these new afterloading bougies in over 150 treatment sessions involving 55 patients, no complications were thus far observed.

Brachytherapy↗
PubMed1993

Piezoelectric shockwave lithotripters: differences in fragmentation efficiency in vitro.

In a comparative assessment of the stone fragmentation efficacy of different piezoelectric lithotripters 72 human gallstones consisting of 24 sets of 3 stones each were disintegrated in vitro using the Piezolith 2300, the EDAP LT.01, and the Therasonic. On the basis of the maximum diameter the calculi were divided into group A (6-15 mm; n = 3 x 16) and group B (16-25 mm; n = 3 x 8) and were treated by using the maximum energy setting of each lithotripter (Piezolith 2300: setting 4, high power; EDAP LT.01: 95%; Therasonic: setting 7). Shockwave application was terminated when the residual fragments measured < or = 4 mm or after a total number of 6000 pulses. With the Piezolith 2300 all calculi could be disintegrated into fragments < or = 4 mm. In contrast, fragmentation was not successful, even after 6000 applied pulses, in the case of 2 and 6 stones when using EDAP LT.01 and the Therasonic lithotripters, respectively. With the remaining concrements of group A (n = 3 x 11) the fragmentation end point was achieved after a lower number of pulses when the Piezolith 2300 (median, 250 pulses; range, 50-500 pulses) was used than with the EDAP LT.01 (1000; 150-2500; p < 0.01) and the Therasonic lithotripters (2750; 750-5500; p < 0.01). Similar results were obtained for group B (n = 3 x 6): the Piezolith 2300 required fewer pulses (200; 100-1250) than the EDAP LT.01 (1000; 500-1000; p < 0.05) and the Therasonic (2000, 500-4000; p < 0.05) units.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholelithiasis↗
PubMed1993

Parameters influencing piezoelectric shock wave lithotripsy of biliary calculi.

A total of 225 human gallbladder stones were divided into sets of two, three, or four identical calculi (with maximum diameters of 6-26 mm) and submitted to piezoelectric shock wave lithotripsy in vitro in order to investigate the influence of the following parameters on stone disintegration: shock wave intensity, pulse frequency, and various physicochemical parameters such as the volume and viscosity of the fluid surrounding the stone, the hardness of the calculus, and its chemical composition. The fragmentation efficacy increased with enhanced shock wave energy (P less than 0.01). If the volume of the fluid (30 mL) surrounding the calculus was small, the disintegration end-point (defined by maximum fragment diameters less than or equal to 4 mm) was achieved after a lower number of pulses (median: 250 pulses) than in the case of a large fluid volume (80 mL) (500 pulses; P less than 0.01). On the other hand, however, factors such as the shock wave pulse rate (0.9 Hz vs 1.6 Hz), variations in viscosity of a water-jelly mixture surrounding the stone, the chemical composition of the stones as determined by X-ray diffractometry, and stone hardness were found to have no significant influence on the fragmentation efficacy.

Cholelithiasis↗