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Biomedical subjects

E Bruch

Publications and source records attributed to E Bruch.

6 recordsLinked to original sources

[Stent implantation as a palliative therapeutic measure in tumor-induced stenoses of the large veins of the body].

PURPOSE: Self-expandable metallic stents were used to treat patients with malignant venous obstructions to determine their effectiveness in producing symptomatic palliation. METHODS: 20 patients with a total of 28 tumour-induced obstructions of the superior vena cava (n = 13), the inferior vena cava (n = 4), the subclavian (n = 4), the innominate (n = 5) and the iliac veins (n = 2) were treated with self-expandable metallic stents. 38 Gianturco stents and 21 Wallstents were applied. Patients were heparinised during the procedure and up to three days afterwards. RESULTS: In all patients correct positioning of the stents was achieved. In 16 patients stent placement resulted in relief of their symptoms. In 8 patients the symptoms completely disappeared without recurrence until death as a result of tumour progression. The follow-up ranged from 10 days to 14 months. In 8 still living patients no re-obstruction occurred (follow-up average three months). In one patient thrombotic stent occlusion occurred 6 days after the procedure; the v. cava superior was reopened again by local urokinase therapy. Three patients finally developed re-occlusion due to tumour progression. In one patient stent placement was complicated by migration of the Gianturco stent one day after stent implantation and reocclusion of the subclavian vein. CONCLUSION: The application of self-expandable metallic stents in patients with malignant venous obstruction is a useful palliative therapy.

Adult↗

Primary sclerosing cholangitis.

Thirty patients, 18 males and 12 females, with PSC have been studied between 1972 and 1986. In nine PSC was associated with ulcerative colitis (30%), in 4 with Crohn's disease (13%) and 17 were free of any chronic bowel disease. Four of these 17 were siblings. Alkaline Phosphatase, Gamma GT, total bile acids and 7-alpha-hydroxilated bile acids were elevated in all patients. In 14 patients plasma and urinary copper as well as ceruloplasmin were studied, showing the copper in all cases and ceruloplasmin in 10 cases elevated, 4 were normal. By means of cholangiography alterations of the extrahepatic ducts, the intrahepatic ducts, and both the intra- and extrahepatic ducts were seen in 13%, 27% and 40% of the cases, respectively. Alterations of the pancreatic duct were observed by pancreatography in 21% of cases. 40% of the PSC-patients had also a Sjögren's syndrome, while 3% were associated with diabetes mellitus Type I and II, psoriasis and red lichen planus, iridocyclitis and hepatic hemangioma.

Adult↗

[Hepatic lesion caused by halogenated anesthetics].

Two patients has been presented to whom general anaesthesia consecutive with halogenated anesthetics has been administrated. In one of the observations the first anaesthesia was administrated with enfluorane and halothane was for the others. The two patients inured with jaundice and in one of them accompanied with hepatic insufficiency; both of them had favourable evolution. The histology of one of them show us a lesion compatible with injury caused by halogenated anaesthesia. In one of the patients appears evidences of hypersensitivity. It is request the possibility that the enfluorane could be acting as a sensibilisant drug of the hepatic injury produced by the halothane. This experience suggest us the danger already described of the consecutive use at short intervals of halogenated anesthetics. So long as fat patients are more sensible to the toxic action of these anesthetics it is suggested prevent in their cases.

Chemical and Drug Induced Liver Injury↗