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F E Kasmin

Publications and source records attributed to F E Kasmin.

At least 19 recordsLinked to original sources
PubMed2001

Endoscopic therapy for chronic pancreatitis.

Endoscopic therapy for chronic pancreatitis is feasible and effective in selected patients. The management of pain and ductal obstruction is most effective if reversal of the obstructive process--stricture or stone--is successful and durable. Multiple endoscopic modalities are available, and new technologies will continue to advance the capabilities of therapeutic pancreatic endoscopists. Adjunctive treatments, such as ESWL, enhance the success of these techniques. These varied therapies, although attractive and theoretically sensible, have not been compared in a randomized, controlled fashion with standard surgical therapies. In this sense, they remain experimental. Nonetheless, these techniques are widely applied in advanced endoscopy centers worldwide, and uncontrolled individual series are expected to continue to expound on and demonstrate the effectiveness of these minimally invasive interventions until randomized, prospective studies become available.

Cholestasis↗
PubMed1997

Biliary tract diseases in the elderly: management and outcomes.

Elderly people commonly present with biliary tract disease. Gallstone disease is an important cause of recurrent abdominal symptoms, and we advocate an aggressive approach in stable patients not at risk to improve the quality of their lives. Choledocholithiasis is optimally treated by ERCP (98% success) even in patients who are at great risk. Endoscopic intervention often obviates the need for emergency biliary tract surgery in the elderly, is better tolerated, and is associated with significantly less risk and a lower mortality. In contrast, emergency surgery in the elderly is poorly tolerated. Even cholecystitis and biliary pancreatitis (not discussed here) are amenable to endoscopic treatment. Malignant biliary obstruction should not and cannot be treated as aggressively as benign disorders affecting the biliary tree as the long term outlook is poor. Endoscopic palliation usually suffices in maximising treatment and improving the patient's quality of life with few associated complications or postprocedural machinations (drainage bags or tubes). The afflicted population in general and the elderly in particular benefit from minimally invasive endoscopic decompression techniques.

Aged↗
PubMed1997

F2-isoprostane and 4-hydroxynonenal excretion in human bile of patients with biliary tract and pancreatic disorders.

OBJECTIVE: To assess parameters of lipid peroxidation in bile of patients with hepatobiliary and pancreatic diseases. METHODS: F2-isoprostanes (F2-IPs) and 4-hydroxynonenal (4-HNE) were measured in bile collected during 31 ERCP procedures using gas chromatography/mass spectrometry. RESULTS: In 11 subjects with normal ERCP (controls), bile contained significant amounts of F2-IPs (188 +/- 27 pg/ml) and 4-HNE (37.5 +/- 8.0 ng/ml). In 10 individuals with bile duct stones, there was a 3-fold increase of F2-IPs (523 +/- 129 pg/ml; p < 0.05) and a 2.5-fold increase of 4-HNE (89.6 +/- 18.0 ng/ml; p < 0.05). In 10 patients with various pancreatic diseases, bile F2-IPs were also enhanced (545 +/- 112 pg/ml; p < 0.01). There was no significant change in alpha-tocopherol, whereas beta-carotene was decreased in biliary tract and pancreatic diseases (p < 0.05). Results of serum liver tests were normal with the exception of bilirubin, which was increased together with alkaline phosphatase. Concentrations of total lipids, phospholipids, and cholesterol did not differ significantly between the three groups. CONCLUSIONS: These data provide the first evidence in humans supporting the role of oxidative stress in the pathogenesis of biliary and pancreatic disease.

Aged↗
PubMed1996

Needle-knife sphincterotomy in a tertiary referral center: efficacy and complications.

BACKGROUND: The use of needle-knife sphincterotomy as a method of precut sphincterotomy has been criticized as potentially unsafe. Despite this, a number of tertiary referral centers have reported their successful use of this technique to increase the rate of common bile duct cannulation. METHODS: We assessed the safety and efficacy of needle-knife sphincterotomy in 72 consecutive patients in whom attempts at standard common bile duct cannulation were unsuccessful. Bile duct diameters were correlated to the complication rate. RESULTS: Cannulation of the common bile duct was successful immediately after needle-knife sphincterotomy in 50 patients (67%), and was successful in 17 of the 20 patients who underwent repeat ERCP, for a total cannulation rate of 93%. Eight patients (11%) experienced complications. Retroduodenal perforation during guide wire cannulation attempts and bleeding occurred as frequently as pancreatitis. Small duct size was a risk factor for complications. There was no procedure-related mortality, and all complications were managed medically. CONCLUSIONS: Needle-knife sphincterotomy was effective in facilitating cannulation in patients in whom standard cannulation attempts failed. Limiting guide wire manipulation of the fresh sphincterotomy site and excluding patients with small duct size may further reduce the complication rate.

Adult↗
PubMed1995

Persistence of the gallbladder following laparoscopic cholecystectomy: a case report.

Laparoscopic cholecystectomy is the technique of choice for cholecystectomy. No experience with congenital abnormalities of the gallbladder has been reported. We report here the case of a 42-year-old woman who developed recurrent symptoms seven months after laparoscopic cholecystectomy and was found to have the majority of her gallbladder still intact. We speculate that the patient had a bilobate gallbladder as the explanation for the mishap. She subsequently underwent open repeat surgery.

Adult↗
PubMed1994

Endoscopic management of cholangitis: critical review of an alternative technique and report of a large series.

OBJECTIVE: To assess the outcome of endoscopic techniques as the solitary treatment modality for the complete management of ascending, bacterial cholangitis, compared with results of radiological and surgical methods as historical controls. METHODS: Endoscopic techniques were used to decompress bile ducts obstructed by stones (898 patients) or stenosis (49 patients). Endoscopic sphincterotomy (ES) was performed in 839 patients, and either 7-Fr straight stents (79), or nasobiliary tubes (29), were utilized as initial therapy in 108 patients. Of these latter patients, 68 subsequently underwent ES and stone removal, 17 had ES, lithotripsy, and stone removal, 18 were left with stents in place, and 5 were lost to follow-up. Follow-up was conducted by direct patient contact, by telephone, or through the referring physicians. RESULTS: All patients were managed by endoscopic techniques. There were four deaths (0.42%) in the first 30 days (none before 2 wk); no deaths were related to the procedures but were attributed to intercurrent medical problems. Two patients underwent surgery: one pancreatitis, one perforation. Complications were infrequent, occurring in 6% of patients. Bleeding occurred in 3%, pancreatitis in 2.8%, and perforation 0.2%. CONCLUSIONS: Endoscopic management of cholangitis is as effective as surgical or radiological methods for managing bacterial cholangitis, a potentially fatal syndrome, but ERCP and ES have been shown to be safer. Endoscopy is the preferred index technique both for establishing a definitive diagnosis and providing therapy.

Aged↗
PubMedDate not supplied

Complications of diagnostic and therapeutic ERCP.

Complications associated with ERCP have been well defined, clinically recognized, and effectively managed conservatively. Few patients require surgery or prolonged hospitalization. The morbidity and mortality associated with ERCP and sphincterotomy have remained low, and, although the outcome of endoscopy is equivalent or better than surgical or radiologic techniques, the complications are less. Despite the general acceptance of ERCP, its therapeutic applications, its more universal performance, and the morbidity and mortality rates have remained the same or lower since its introduction a quarter of a century ago.

Bile Duct Diseases↗