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Biomedical subjects

F Hagenmüller

Publications and source records attributed to F Hagenmüller.

At least 37 records · Page 2Linked to original sources
PubMed1992

Biliary stent occlusion--a problem solved with self-expanding metal stents? European Wallstent Study Group.

The main limitation in the endoscopic palliation of malignant biliary obstruction is due to stent blockage. One of the factors thought to be of importance is the diameter of the endoprosthesis. In this paper, we report the results of a multicenter European study with a one cm diameter self-expanding metal stent (Wallstent) in 103 patients with malignant biliary obstruction. Insertion of the stent following guidewire positioning was successful in 97.1% of the patients without any cases of de novo cholangitis developing after the endoscopic procedure. The median follow-up for the entire group was 145 days. In all but 3 patients, the stent expanded to more than 80% of its maximum diameter. Two patients had ongoing cholangitis after stent insertion. Long-term complications manifested by late cholangitis, were seen in 18% of the cases after a median interval of 125 days. The occlusion rate by biliary sludge was 5% after a median time period of 175 days which is substantially less than the 21% occlusion rate reported for polyethylene stents. In conclusion, our results show that the Wallstent can be easily placed in distal and mid-CBD strictures after guidewire passage, with most of the patients having a- good drainage effect. The occlusion rate by biliary sludge is significantly less than for conventional polyethylene stents, but the occlusion by tumor ingrowth is substantial. A disadvantage is the high cost of the Wallstent. Further randomized trials will be required to determine the cost-benefit ratio for the use of this stent.

Adult↗
PubMed1991

Fish oil reduces ethanol-induced damage of the duodenal mucosa in humans.

Eight healthy volunteers were studied before and after 3 weeks of dietary supplementation with fish oil (10.5 g day-1, 18% (1.9 g) eicosapentaenoic acid). Duodenal mucosal lesions were induced by instillation of 40 ml ethanol (40%). Mean endoscopic lesion score was lower after fish oil treatment (1.62 +/- 0.32; mean +/- SEM) than before (3.25 +/- 0.31; P less than 0.01). Histologic lesion score fell from 22.75 +/- 1.98 before treatment to 13.50 +/- 1.51 after fish oil (P less than 0.01). Basal and pentagastrin-stimulated gastric acid output remained unaffected. Release of prostaglandin E2, 6-keto-prostaglandin F1 alpha, and thromboxane B2 from biopsy specimens of the duodenal mucosa in vitro was not significantly altered after fish oil ingestion. In the same in vitro system calcium ionophore A23187-induced release of total leukotriene C (LTC) increased from 10.6 +/- 1.5 ng g-1 mucosa 20 min before treatment to 30.4 +/- 3.2 ng after fish oil. High pressure liquid chromatography analysis showed that this increase was partly due to formation of LTC5 as after fish oil 28% of total LTC were identified as LTC5 whereas 72% were LTC4. We conclude that in humans fish oil reduces ethanol-induced damage of the duodenal mucosa without inhibiting gastric acid secretion or stimulating prostaglandin formation. It remains to be clarified if the changes in leukotriene formation are relevant for the mucosaprotective fish oil effect.

6-Ketoprostaglandin F1 alpha↗
PubMed1991

[Self-expanding and expandable bile duct prostheses].

The main problem of conventional endoscopic or percutaneous biliary drainage is the clogging of plastic endoprostheses. Therapeutic advances may be achieved by self-expanding or balloon-expandable braided or slit metal stents due to their large lumen and small surface area. Preliminary clinical studies show excellent early results but a divergent long-term clinical outcome depending on the selection of patients, the implantation technique or the type of the stent. If a long-distance overlap of biliary stenoses is achieved the metal stents may be superior to plastic prostheses due to a reduction of the risk of bile encrustation.

Bile Duct Neoplasms↗
PubMed1990

[Endoscopic and percutaneous implantation of self-expanding endoprostheses in biliary stenosis].

Self-expanding metal stents were implanted in 30 patients (14 men and 16 women, mean age 67 [40-86] years) with malignant (n = 27) or benign (n = 3) obstruction of the biliary tract (hepatic duct bifurcation: n = 14; choledochal duct: n = 16). The stents were introduced and left in place endoscopically in 13, percutaneously and transhepatically via a 7 or 9 F catheter in 17 patients. The stents, which expand to a diameter of 7-10 mm, in all cases achieved complete drainage, as confirmed by cholangiography. Jaundice completely disappeared in 28 of 30 patients. No complications were noted during a 30-day period of observation. After a median follow-up period of 90 days, 17 patients have been without jaundice for a median period of 141 (30-330) days. A recurrence of jaundice was noted in three patients (restenosis proximal to the stent in 2, incrustation with bile in one). Ten patients died, without any signs pointing to stent occlusion. These data indicate that the probability of stent patency in malignant stenoses of 200 days after implantation is 84%, so that stents in most cases provide a safe and effective means of drainage. Because they have a relatively large lumen with small surface area infection, occlusion and migration apparently occur less often than with conventional synthetic prostheses.

Adult↗
PubMed1990

Toxic shock-like syndrome due to severe hemolytic group A streptococcal infection.

A 33-year-old woman suffering from anal erosions developed severe illness with fever, diarrhea, ischalgia, hypotension, acute abdominal pain, dyspnea, renal and hepatic impairment, myalgia, desquamation of the skin, leukocytosis, anemia, hypocalcemia, decreased serum albumin, and cholesterol levels. Exploratory laparotomy did not reveal pathologic findings. Hemolytic group A streptococci were grown from peritoneal swabs and pleural exudate in bacteriologic cultures. The patient slowly recovered after intense penicillin and tobramycin therapy.

Adult↗
PubMed1990

[Electromagnetic shockwave lithotripsy of gallstones. Preliminary clinical experiences].

75 applications of extracorporeal electromagnetically produced shock-waves were performed on 40 patients with symptomatic gallbladder stones (27 women and 13 men; mean age 43.5 [25-69] years). The patients had up to three stones each, with a maximal diameter of 35 mm. Computed tomography revealed partial calcification of the stones in nine patients. Stone fragmentation succeeded in all patients. Two weeks after lithotripsy two patients were free of stone. Maximal fragment diameter, as measured by ultrasound, was less than 6 mm in 19 patients, 6-10 mm in 14, and 11-15 mm in five. At reexamination of 24 patients three months later, three additional patients were free of stone by ultrasound. No significant side effects were noted during the first 30 days after the procedure. But during further observation mild pancreatitis developed in two, while in one choledochal concrements caused obstructive jaundice which necessitated endoscopic papillotomy. These results demonstrate the effectiveness of this method of fragmenting gall-bladder stones.

Adult↗
PubMed1990

A 19-year-old female with blue rubber bleb nevus syndrome. Endoscopic laser photocoagulation and surgical resection of gastrointestinal angiomata.

A case of a blue rubber bleb nevus syndrome in a 19-year-old female patient with multiple cutaneous and gastrointestinal hemangiomata is described. Recurrent GI bleeding resulted in severe chronic anemia, which was successfully treated by endoscopic laser photocoagulation and surgical resection. Both forms of therapy had to be repeated 4 years later, the patient having been well in the meantime. This combined endoscopic and surgical approach might also improve the survival of patients with severe GI hemorrhage due to blue rubber bleb nevus syndrome.

Adult↗
PubMed1990

Effect of N-butylscopolamine on sphincter of Oddi motility in patients during routine ERCP--a manometric study.

N-butylscopolamine is a generally accepted drug for the suppression of gut motility. Although it is used during routine ERCP, only few systematic studies have been carried out in patients to investigate its action on sphincter of Oddi motility. In the present study the effect of N-butylscopolamine on the motility of the sphincter of Oddi region has been evaluated in 17 patients undergoing routine diagnostic ERCP. The pressure parameters of these patients were compared with "normal values" obtained in 23 volunteers. A dose of 40 mg of N-butylscopolamine bromide (Buscopan) i.v. significantly reduced the contraction frequency of the sphincter of Oddi from 5.4 +/- 1.2/min to 1.0 +/- 1.4/min (p less than 0.001), the contraction amplitude from 106.3 +/- 27.8 mmHg to 55.2 +/- 23.5 (p less than 0.01) mmHg, and the basal sphincter of Oddi pressure from 13.9 +/- 3.0 mmHg to 11.0 +/- 3.5 mmHg (p less than 0.05), but had no effect on the pressure gradient between the common bile duct and the duodenum. These results clearly demonstrate that N-butylscopolamine inhibits contractions of the sphincter of Oddi, and may thus facilitate the intubation of the papilla.

Adult↗
PubMed1990

[Extracorporeal shockwave lithotripsy of pancreatic calculi].

Extracorporeal shock-wave fragmentation of pancreatic stones is a complementary non-surgical treatment in selected patients with chronic pancreatitis. The procedure has proven to be safe and technically effective. Preliminary clinical results indicate therapeutic success rates in terms of pain disappearance or reduction in more than 90% of the patients. The indication should be taken into consideration before surgical intervention.

Adult↗
PubMed1989

Endostomy: a new approach to small-bowel endoscopy.

A percutaneous access to the gastrointestinal hollow organs created by new endostomy tubes permits diagnostic and therapeutic endoscopy in particular of the small intestine. A case of a patient with chronic gastrointestinal bleeding of hitherto unknown origin, in whom enteroscopy and electrocoagulation of an angioma in the lower jejunum was performed, is presented.

Chronic Disease↗
PubMed1989

Self-expanding biliary stents: preliminary clinical experience.

Nine self-expanding metallic stents were implanted in 7 patients to relieve biliary obstruction. One patient had a benign stricture and 6 patients had malignant stenoses. The stent was inserted percutaneously on a 7 F delivery catheter in 6 patients. Endoscopic transpapillary implantation was performed in one patient. After release the stent expanded to a diameter of 8-10 mm. The correct position was checked by fluoroscopy and cholangiography. In addition, percutaneous cholangioscopy was carried out in 6 patients. No complications were observed within 30 days. Clinical improvement was seen in all patients. After a mean follow-up period of 11 weeks (range: 3-17) 6 of the 7 patients are still alive with no evidence of biliary reobstruction. One patient died of disseminated malignancy. The initial results are promising. The wide-bore diameter, the macroporous configuration and the small surface area of the implanted self-expanding stents would seem to be associated with lower rates of infection, clogging and migration as compared with conventional endoprostheses. Further trials are warranted to determine the future role of self-expanding stents in biliary obstruction.

Adult↗
PubMed1989

[Palliative treatment of malignant stenoses of the esophagus and cardia: laser therapy versus laser + high-dose-rate Iridium 192 afterloading therapy. A prospective randomized study].

In order to compare the local efficiency of two different therapy modalities, 37 patients with advanced inoperable tumors of esophagus and cardia were evaluated hitherto in a prospective randomized study. Twenty patients received an exclusive laser treatment, 17 were additionally submitted to three high-dose-rate iridium-192 afterloading irradiations (single dose at the reference point 1 cm radially to the source: 7 Gy). In both groups, 15 patients died whose survival times were not different (125 versus 130 days), however, a beneficial influence was exerted by the afterloading therapy with respect to the duration of the palliative effect (67 versus 28 days) and the hospitalization time (25 versus 48 days).

Adenocarcinoma↗
PubMed1989

Optical performance of electronic imaging systems for the colon.

Electronic (video) endoscopes are a significant new development in gastroenterology, offering the potential of enhanced teaching and permanent storage of pictorial data. The primary concern of gastroenterologists is the resolution and color performance of these instruments, as these parameters have important bearings on the ability to discern pathological changes in mucosa. We sought to determine the resolution and color capabilities of electronic colonoscopes and compare them with a conventional fiber colonoscope. Resolution was determined using a standard test chart at various distances and the number of picture elements (a measure of resolution) was calculated. The mean number of picture elements was Fujinon (219), Fiber (172), Pentax (169), Toshiba (142), Olympus (140), and Welch Allyn (133). In close focus examination (target distances less than 1 cm), the Fujinon and Toshiba endoscopes had significantly higher resolution than the other instruments. Color was measured quantitatively using a standard color chart and a color analyzer. Color polygons were plotted for each endoscope on a reference chromaticity diagram. All systems had an acceptable overall performance but color was undersaturated with some systems. The optical performance of electronic endoscopes has improved considerably since the inception of electronic endoscopy.

Colonoscopes↗