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C Jakobeit

Publications and source records attributed to C Jakobeit.

At least 19 recordsLinked to original sources
PubMed1997

[Transcutaneous sonography of the gastroesophageal junction in prospective comparison with endoscopy].

BACKGROUND AND OBJECTIVE: Despite its practical value, few data exist on assessing the gastrooesophageal junction by transcutaneous sonography (TS). A prospective study was undertaken to compare TS and endoscopy (ES) of this region. PATIENTS AND METHODS: Between 1 September, 1994 and 31 May, 1995 TS of the lower oesophagus was followed by ES of this region in 211 patients (116 women, 95 men; mean age 58.9 [14-90] years). None had previously been examined by ES or radiological contrast study of the oesophagus and stomach. Endoscopist and sonographer were blinded to each other's findings. The ability to visualize the abdominal oesophagus by TS and to recognize abnormalities were compared with ES results, both quantitatively and descriptively. RESULTS: The diaphragmatic course of the terminal oesophagus or (where present) a gastric hernia were well visualized by TS in all 211 patients. In 78 patients with normal results on TS and ES the visible length of the oesophagus was 3.3 +/- 0.8 cm, with a wall thickness of 4.5 +/- 1.0 mm (mean +/- standard deviation). In seven of eight patients with echo-poor wall thickness between 9 and 27 mm, suspected of being malignant, ES revealed neoplasm of the terminal oesophagus or cardia (six T2 to T4 carcinomas; one MALT lymphoma). One patient had involvement of the oesophagus and cardia as part of Crohn's disease. No case of malignancy remained unrecognized by ES. 64 of 77 hiatal hernias diagnosed by ES were also recognized by TS. Hiatal hernia was falsely diagnosed by TS in four patients. Oesophageal varices were correctly identified by TS in three of eight patients, as was one case of achalasia. CONCLUSION: Transcutaneous sonography is a good screening method with a high sensitivity for changes in wall architecture and it provides indications for further selective diagnostic procedures.

Adolescent↗
PubMed1996

[Endoscopic therapy in acute hemorrhage caused by duodenal diverticula].

HISTORY AND CLINICAL FINDINGS: A 70-year-old previously healthy woman had been feeling nauseous for one day and had passed several liquid tarry stools. A barium meal previously done as an out-patient had shown a duodenal diverticulum 3.5 cm in diameter with marked contrast-medium retention. Her general condition was impaired, her skin pale and cold, while heart rate and blood pressure were normal. Rectal examination confirmed tarry stool and thus suggested upper gastrointestinal bleeding, the contrast-medium retention pointing to the duodenal diverticulum as a likely site. INVESTIGATIONS: Haemoglobin concentration was 9.1 g/dl, the haematocrit 26.6%. Total protein was reduced to 4.4 g/dl. Esophagogastroduodenoscopy (performed about 10 hours after the barium meal) showed erosion at the duodenal bulb and contrast retention in the juxtapapillary diverticulum, but no acute bleeding was discovered. TREATMENT AND COURSE: Repeat endoscopy on the following day revealed acute bleeding (Forrest stage Ia) from an arterial stump in the diverticulum. It was stopped with local injection of adrenaline (6 ml of 1:10,000 solution) and fibrin glue, but the injections had to be repeated twice. Another endoscopy 30 days after the first showed merely a mucosal scar. CONCLUSION: Early endoscopy enables one to make the diagnosis and to provide minimally invasive treatment of bleeding from a duodenal diverticulum.

Acute Disease↗
PubMed1996

[Extracorporeal shockwave lithotripsy (SWL) of common bile duct calculi without previous endoscopic papillotomy].

In 17 patients (8 men, 9 women; mean age 61.5 years) with problematic bile-duct stones (papilla endoscopically inaccessible, residual bile-duct stones after recent laparoscopic cholecystectomy or age below 25 years) the chances of successful treatment by ESWL without sphincterotomy were examined. In 15 patients with solitary stones measuring up to 14 mm "pulverization-ESWL" produced complete freedom from stones after spontaneous migration of fragments through the intact papilla. Only two patients with two ductal stones measuring up to 15 mm still had residual fragments in the bile duct after treatment. The ideal stone for ESWL without sphincterotomy is thus the solitary bile-duct stone measuring up to 14 mm. Before performing a high-risk sphincterotomy, before re-operation and in young patients one should therefore always examine whether ESWL without sphincterotomy is indicated.

Adolescent↗
PubMed1995

[Non-contact argon gas coagulation in flexible endoscopy of the gastrointestinal tract: in vitro studies and initial clinical experiences].

Diathermocoagulation is indispensable in interventional endoscopy. The argon beam coagulation represents an innovative electrocoagulation method, where high-frequency alternating current is conducted to tissues by ionized argon gas without contact. Before clinical application we performed in vitro studies to evaluate depth and diameter of tissue coagulation of fresh resectations from stomach, small intestine and colon. Power and gas flow were graduated in five steps from 40 to 155 W and from 2 to 7 l/min respectively. Coagulation time (1 s-10 s) and angle of the probe in relation to tissue surface (45 degrees, 90 degrees) were varied. The maximal depth of necrosis was 2.4 mm, the maximal diameter 1.1 cm. There was no perforation found, even in critical areas like colon and duodenum. Accordingly argon beam coagulation was performed in 41 consecutive patients. The power and gas flow were varied in two stages between 40 and 75 watts and 2 and 3 l/min respectively. Coagulation time and angle of the probe were handled individually. In 32 of the 33 patients with bleeding from angiodysplastic lesions or polypectomy sites, with oozing of blood from erosions or ulcers or with bleeding due to vascular penetration by tumors definitive hemostasis was achieved in one to two sessions. In all of the four patients with residual sessile adenoma tissue complete removal was possible. Esophageal patency was restored in all four patients with stenosing tumors. In one patient with angiodysplasia of the cecal pole an asymptomatic accumulation of gas in the submucosa was observed which cleared spontaneously. In two patients with extensive esophageal carcinoma there was a transitory--also asymptomatic--accumulation of gas in the mediastinum and peritoneal cavity but no reference to perforation. The non-contact argon electrocoagulation is in gastrointestinal endoscopy an effective and non-expensive alternative to laser-technique.

Adenomatous Polyps↗
PubMed1994

[ESWL-therapy of pancreatic duct calculi].

In 23 patients suffering from pancreatic duct stones, extracorporeal shock wave lithotripsy (ESWL) was performed in combination with endoscopic sphincterotomy (EST). Calculi-disintegration and resolution of obstruction was achieved in all cases. Completely stone-free ducts were achieved in 7 patients, some peripheral asymptomatic stone material remained in 16. 8 patients became completely asymptomatic, 11 reported a marked reduction of their pain. 15 patients gained weight. No major complications were observed. ESWL combined with EST is a successful non-operative new treatment option in pancreatic stone disease.

Adolescent↗
PubMed1994

[Chronic mesenteric ischemia--a rare differential diagnosis of Crohn disease].

A 59-year-old patient was treated for six years assuming Crohn's disease. Recurrent segmental colitis, spontaneous perforation of the jejunum and chronic weight loss were suggestive of this diagnosis despite a missing typical histology, even in the resected part of jejunum. Only unspecific inflammatory changes were found. Typical angina abdominalis occurred late. Angiography showed a complete occlusion of the coeliacaxis and both mesenteric arteries. Only the slow progress of occlusion of the visceral arteries with extensive collateral circulation from iliacal arteries explains the absence of severe bowel infarction. After aortomesenteric bypass operation the patient is without any complaint.

Angiography↗
PubMed1993

Ultrasonography and biliary extracorporeal shock-wave lithotripsy.

The results of shock-wave treatment of gallbladder stones depend to a very high degree on the quality and expertise of ultrasonography applied before, during, and after shock-wave disintegration of the stones. Ultrasonography is decisive in evaluating the inclusion criteria; it is the method of choice for directing the shockwave energy at the stones and monitoring the disintegration process. It is the only diagnostic modality to really demonstrate the gallbladder being free from stones.

Bile Duct Diseases↗
PubMed1993

[Extracorporeal shockwave lithotripsy of problem bile duct calculi].

ESWL is a new gentle, very effective, poor-risk technique in treatment of extrahepatic problematic bile-duct stones. This method might substitute surgical choledochotomy to a great extent. ESWL is a new therapeutic alternative to achieve nonoperative freedom of stones or, at least, to treat biliary obstruction in intrahepatic bile-duct stones, which are not treatable by endoscopic operative methods.

Anastomosis, Roux-en-Y↗
PubMed1993

[Extracorporeal shockwave lithotripsy of gallbladder calculi].

Shockwave disintegration of gallbladder stones with lythic therapy of residual fragments is successful when all criteria of patient- and stone-selection, shockwave application and lysis are fulfilled. The "Four-S-stones" proved to be the best candidates: solitary, symptomatic, sonolucent in a sufficiently contractile gallbladder. The rate of complications is low. Stone recurrence rate (10 to 15% after three years) is much lower as in previous studies using lythic therapy only. The new therapeutic approach to gallbladder stone disease with fragmentation, spontaneous fragment-clearance and lysis of residual fragments is--as the only truly non-invasive procedure--for 10 to 20% of the patients an alternative equal to operation.

Chenodeoxycholic Acid↗
PubMed1993

[Extracorporeal shockwave lithotripsy of bile duct calculi].

Shockwave therapy of bile duct stones is not dependent on difficult preconditions concerning stone-volume and -composition or subsequent lythic therapy. Its main indication is failure of endoscopic sphincterotomy (EST). Shockwave lithotripsy of bile duct stones--which may even be carried out even instead of EST in specific cases--is with a success rate of 80 to 95% as effective as shockwave lithotripsy in urology.

Bile Ducts↗
PubMed1993

[Extracorporeal shock wave lithotripsy of an impacted gallstone in cholecysto-antral fistula].

The endoscopic examination of a patient with gastrointestinal bleeding unexpectedly revealed a cholecysto-antral fistula with incipient penetration of a gallstone into the stomach (and presumably intermittent bleeding from the fistula rim). As endoscopic extraction was not possible and the stone impacted in the fistula was visible in the ultrasound scan extracorporeal shock-wave lithotripsy was carried out. An electrohydraulic lithotripter was used and 1,913 shock waves were applied at a maximum of 26,000 volts. In a single treatment session the stone was disintegrated completely into fragments small enough for spontaneous elimination. No sedative or analgesic medication was required. There was no evidence of any complications or side-effects following the ESWL.

Aged↗
PubMed1992

[Biliary extracorporeal shock-wave lithotripsy].

Since 1985/86, more than 200 patients with problematic intra- and extrahepatic bile duct stones were treated with ESWL. Results are excellent and comparable with ESWL's success-story in urinary stone disease, abandoning widely open surgery for bile duct stones. In gallbladder-stone treatment, ESWL (always combined with bile acid litholysis) is only promising or successful in a carefully selected subset (10 to 15%) of all symptomatic patients (with good gallbladder contractility, limited stone volume and sonolucent stones).

Cholelithiasis↗
PubMed1992

[Liver biopsy].

Explore the source record for details and available documents.

Biopsy, Needle↗
PubMed1992

[Extracorporeal shockwave lithotripsy in gallstone perforation].

A 78-year-old man with rheumatoid arthritis, arteriosclerosis and cardiac arrhythmias (Lown grade IVb) was admitted to hospital because of haematemesis. Gastroscopy revealed a narrow, deformed duodenal bulb with a bleeding ulcer crater on the posterior wall and a mucosal protrusion 1 cm in diameter. In the course of the illness the duodenal bulb obstruction increased further and there was recurrent vomiting. Repeat gastroscopy 7 days later showed a gallstone, about 4 cm in diameter, which had perforated into the duodenal bulb and could not be removed endoscopically. Because of the serious nature of the other diseases an operation was not undertaken, but an ultrasound-guided extracorporeal shockwave lithotripsy was performed. In three sessions this succeeded without complication to break up the stone, the larger fragments of which were then removed endoscopically while the small ones passed through the gut spontaneously. Subsequent ultrasonography demonstrated a shrunk, stone-free gallbladder with a cholecystoduodenal fistula. Afterwards the patient was again able to take food by mouth without any problems.

Aged↗
PubMed1992

[Sonography and biliary extracorporeal shockwave lithotripsy (ESWL)].

Ultrasound is an indispensable tool for preliminary diagnosis ("filter function"), during treatment ("monitoring function") and in the follow-up examinations ("follow-up function") after shock-wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which present-day experience has shown to be rare.

Cholelithiasis↗
PubMed1992

[Sonography and biliary extracorporeal shockwave lithotripsy].

Ultrasound is an indispensable tool for preliminary diagnosis ('filter function'), during treatment ('monitoring function') and in the followup examinations ('follow-up function') after shock wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which experience to date has shown to be rare.

Cholelithiasis↗
PubMed1991

[Which factors promote chronic alveolar hypoventilation in patients with obstructive sleep apnea?].

The pathogenesis of obesity hypoventilation is incompletely understood. We investigated 505 patients with sleep apnoea in respect of determinants that correlate with chronic hypercapnia. 14 patients (2.8 per cent) exhibited daytime hypercapnia (PCO2 greater than or equal to 45 mmHg). Compared with the entire group of patients, these patients showed heavier overweight (p less than 0.001) and their nightly respiratory dysregulation defined by the apnoea index was more severe (p less than 0.001). If these patients were compared with 14 normocapnic controls matched for apnoea index, weight and age, there was no difference in respect of lung function data. We conclude that overweight and the severity of sleep apnoea are determinants that predispose to chronic alveolar hypoventilation.

Adult↗