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H J Brambs

Publications and source records attributed to H J Brambs.

At least 109 records · Page 6Linked to original sources
PubMed1996

Treatment of bile duct stones: value of laser lithotripsy delivered via percutaneous endoscopy.

Extraction of stones from the bile ducts via standard endoscopic techniques, a percutaneous transhepatic approach, or a T-tube track can be unsuccessful. We report our preliminary experience with a combination of percutaneous cholangioscopy and dye laser lithotripsy. Flash lamp-excited dye laser (504 nm) lithotripsy delivered by percutaneous cholangioscopy (12 F) was evaluated in 13 patients with stones in the bile ducts. Conventional endoscopic treatment had not been attempted in 4 patients after hepaticojejunostomy and had failed in 3 patients after gastric bypass surgery or gastrectomy, and in 6 patients because of technical difficulties, i.e. due mainly to largeness of stones. In 12 patients a percutaneous transhepatic route was used. In 1 patient the T-tube track was used as access to the bile ducts. Laser lithotripsy resulted in successful fragmentation of stones in 12 patients (92%). The bile ducts cleared spontaneously in 2 patients only. Using additional techniques, i.e. sphincterotomy and stent insertion, the overall combined success rate for duct clearance after laser fragmentation was 100%. Four patients had a retrograde endoscopic sphincterotomy after failed attempts for stone removal at endoscopic retrograde cholangioscopy. Two patients had an antegrade fluoroscopically monitored sphincterotomy. Bleeding complications occurred in 2 patients. This accounted for a high rate (15%) of severe complications. The intrahepatic bleeding in 1 patient was due to an intrahepatic vessel injury by the 13-F sheath. The periampullary bleeding in the other patient occurred after an antegrade papillotomy. Pulsed dye laser lithotripsy proved to be an effective technique in patients with difficult bile duct stones. The main problem of a per cutaneous approach is the complete removal of the fragmented stones, which requires additional procedures in most cases. The percutaneous access is time-consuming and bears a relatively high risk of major bleeding complications. It should therefore be restricted to cases in which conventional endoscopic procedures are impossible or unsuccessful.

Adult↗
PubMed1996

[Solid pseudopapillary tumors of the pancreas].

We report on three female patients with solid pseudopapillary tumors of the pancreas. The histogenetic origin of this entity is still unclear. The tumor, usually occurring in young women, forms large masses (up to 10 cm in diameter) before becoming symptomatic. Metastases have very rarely been reported. In contrast to other pancreatic tumors, the main pancreatic duct was displaced, but of normal caliber without stenosis, in all our patients. Despite the large size of the tumors, they were curatively resected in all three cases. Two of the tumors infiltrated the parenchyma or adipose tissue of the pancreas but did not spread into the lymph nodes or other organs. All of the patients are alive and without signs of tumor recurrence up to 8 years after surgical resection.

Adult↗
PubMed1996

[Developmental anomalies and congenital diseases of the pancreas].

Developmental anomalies of the pancreas result from fusion failure between the dorsal and ventral pancreatic ducts (pancreas divisum) or from rotational failure of the ventral bud (pancreas anulare). These variations and anomalies of the ductal anatomy can be asymptomatic throughout life or can cause varying symptoms in different age periods. Pancreas divisum and pancreas anulare can be confirmed exclusively by means of pancreatography. Congenital disorders of the pancreas derive from genetic defects involving different organ systems, which usually dominate the clinical symptoms. Developmental anomalies and congenital disorders of the pancreas lead to varying morphological alterations of the organ which can be assessed by means of modern imaging.

Adult↗
PubMed1996

[Mini-probe ultrasound of the upper gastrointestinal tract--1995 state of the art and perspectives. Workshop on Mini-Probe Ultrasound in Gastroenterology, Münster, 28 October 1995].

Endoscopic ultrasound (EUS) allows for intraluminal sonographic imaging of the oesophagus, stomach, pancreatobiliary duct system, the papilla of Vater, as well as the colon and rectum. EUS has proved valuable for diagnosis and staging of tumours of the upper intestinal tract. EUS can also provide valuable additional information concerning lesions that cannot be immediately classified. As doing this involves, first, removal of the conventional endoscope and, second, insertion of the echo endoscope, EUS is not suitable for routine examinations. Therefore EUS has remained an independent endoscopic diagnostic modality. Moreover, due to their diameter conventional echoendoscopes cannot be inserted into the pancreatobiliary duct system. Fine calibre high frequency ultrasound probes promise a resolution of less than 2 mm in diameter. The following report is a summary of a one-day workshop which took place in Muenster, Germany on Oct. 28, 1995. Its goal was to define the current state of the art of miniaturised endoscopic ultrasound probes in the field of gastroenterology. During this workshop, possible clinical applications for diagnosis, therapy, as well as follow-up were described and discussed. The potential of miniaturised endoscopic ultrasound probes was explored in terms of possible future technical developments.

Endoscopy, Gastrointestinal↗
PubMed1996

Experimental evaluation of the optimal in-vitro conditions for bipolar electrocoagulation in the bile duct.

BACKGROUND AND STUDY AIMS: Although there have been many reports concerning the therapeutic use and potential of laser and monopolar electrocoagulation therapy, little has been published on the effects of bipolar electrocoagulation on biliary tissue. Although it has been reported that endoscopic recanalization of malignant stent obstruction using bipolar electrocoagulation is an advantageous form of treatment, the optimal parameters for this type of treatment have not yet been determined. The purpose of this prospective study was therefore to evaluate, under in-vitro conditions, the maximum applicable energy required; the influence of probe angle and duration time on the extent of the coagulation achieved; and whether multiple intermittent short pulses show any significant differences in the extent of coagulation achieved, in comparison with the use of a single continuous pulse. PATIENTS AND METHODS: In this in-vitro study, experiments were carried out in 84 common bile ducts from freshly slaughtered swine. The extension of tissue injury after electrocoagulation treatment was measured at 60 combinations of varying levels of power output, probe angles, duration times, and pulse patterns. All of the results were correlated with the diameter of the untreated and normal bile duct walls under in-vitro conditions. RESULTS: When energy was applied at levels up to a maximum of 16 J, the extension of tissue coagulation was about 58% of the untreated bile duct wall diameter. Energy settings exceeding 16 J involved the whole wall diameter in most cases, often including the periductal fatty tissue. Additional energy applications higher than 16 J, 32 J, and 100 J, showed undesirable tissue changes, such as an increasing diameter in the treated bile duct walls of up to 56.8% of the wall diameter of control specimens. CONCLUSIONS: The study evaluated the standard settings in an in-vitro model. The results indicate that protective and effective use of bipolar electrocoagulation on normal porcine bile duct tissue requires: the use of a low power setting (less than 16 J); the use of continuous short pulse patterns; placement of the probe tip at an obtuse angle (0 degree); and the use of short application times.

Animals↗
PubMed1996

[Clinical relevance of mammography in men].

PURPOSE: During a period of four years 104 mammograms were performed in 89 men. Mastectomies were carried out on 23 men (group 1). 66 patients (group 2) were followed up clinically and in 15 patients serial mammograms were obtained. MATERIAL AND METHOD: In group 1 there were 5 patients with bilateral gynaecomastia, 9 with unilateral gynaecomastia and two with pseudogynaecomastia and there were 7 patients with malignancies. In group 2 there were 46 patients with bilateral gynaecomastia and 10 patients with unilateral gynaecomastia. Pseudogynaecomastia was found in 25 patients. There were 7 malignancies, of which 5 had been suspected clinically and one had been diagnosed as gynaecomastia by mammography. Two carcinomas in situ were missed clinically and also by mammography. CONCLUSION: When malignancy is not suspected on clinical grounds the first examination should be sonography, mammography being reserved for cases of doubt. Where, however, malignancy is suspected, and for follow-up, mammography retains its primary position.

Adolescent↗
PubMed1996

[Superselective intra-arterial chemotherapy in therapy-refractory lymph node recurrences of breast carcinoma].

PURPOSE: To demonstrate a superselective intraarterial chemotherapy as a therapeutic alternative in the treatment of previously treated recurrent lymph node metastases in breast cancer. METHODS: 14 patients with recurrent lymph node metastases in cases of breast cancer were presented to be treated by intraarterial chemotherapy of 25 mg mitoxantrone/m2 over a period of 24 hours. In two patients with superclavicular lymph node involvement an intraarterial therapy could not be carried out because of a vascular connection to the anterior spinal artery. Involved lymph stations could be reached in superselective technique by side branches of the subclavian artery. Heparin coverage was given intravenously. Every patient had had surgery, radiation, systemic chemo- and hormonal therapy before and was now graded as inoperable. Therapy indication was given by local tumour-induced symptoms. RESULTS: In the 12 treated cases complete remission was seen in three, partial remission in 4, a steady state in two and a progressive disease in three. There were no complications or severe side effects. CONCLUSION: Intraarterial chemotherapy is an effective and well tolerated treatment in recurrent lymph node metastases in cases of breast cancer even if conventional therapies can no longer be used.

Adult↗
PubMed1996

[Superselective embolization of tumor nodes in solitary kidney in inoperable patients].

PURPOSE: Evaluation of superselective embolisation of renal tumours in inoperable patients with solitary kidneys. METHODS AND PATIENTS: Eight inoperable patients with solitary kidneys bearing tumour nodules underwent 1-3 superselective embolisation procedures with ethibloc (5x) or polyvinyl alcohol (1x). Renal function was monitored with creatinine levels. Tumour size was controlled every three months by means of sonography. RESULTS: Technical success rate was 100%. In 3/3 patients haematuria could be stopped. Post-embolisation renal function was unchanged in 6 patients and deteriorated in two patients; creatinine level rose to a maximum of 2.2 mg%. We observed no other side effects. Seven of eight patients died during a median follow-up period of 9.3 months (4-18 months); in two cases they died due to their underlying malignant disease. One patient had local tumour progress. CONCLUSIONS: Superselective embolisation of renal tumours in patients with solitary kidneys may be a helpful, well-tolerated therapeutic option in inoperable, symptomatic patients.

Adult↗
PubMed1996

[Epidurography: comparison with CT, spiral CT and MR epidurography].

PURPOSE: The purpose of this study was to explain the origin of image patterns demonstrated by conventional epidurography, which is a controversially discussed topic in recent literature. MATERIAL AND METHODS: After introduction of thoracic epidural catheters and iopamidol injection, conventional epidurography and CT-epidurography were performed on 25 preoperative patients. After injection of Gadolinium-DTPA MR-epidurography was performed in two patients treated for chronic pain with already introduced epidural catheters. Three volunteers also underwent identical imaging after introduction of thoracic epidural catheters and in addition helical-CT epidurography using twin-beam technology. RESULTS: 40% of the patients demonstrated the railroad track phenomenon. We were able to prove that it is a sign of a rhythmically variable filling of segments of the lateral epidural space with contrast medium 76% of the patients demonstrated no ventral epidural space at the thoracic level. 56% of the patients showed a medial area of translucence combined with a band-shaped contrasting of the epidural space in the standard ap view. This was proven in all cases to be a plica mediana dorsalis by CT. In all volunteers who underwent helical-CT and MR epidurography we observed the railroad track phenomenon and the filling defect of the anterior thoracic epidural space. CONCLUSION: CT epidurography is well suited for obtaining new insights into the interpretation of findings obtained by conventional epidurography.

Analgesia, Epidural↗
PubMed1996

[The value of MR-mammography at 1.5 tesla in the differential diagnosis of non-puerperal mastitis and inflammatory breast carcinoma].

PURPOSE: The distinction between mastitis and inflammatory breast carcinoma is an important one. Current methods of evaluation including mammography, ultrasound and clinical examination do not enable this distinction. Dynamic magnetic resonance mammography (MRM) is a study with potential in this regard. MATERIAL AND METHODS: 12 patients, in whom clinical examination, mammography and ultrasound could not distinguish between both diseases, were reviewed retrospectively by means of MRM using a 1.5 T Siemens Magnetom SP and a circular mamma coil. We used dynamic 3-D gradient echo sequences with a duration of one minute. RESULTS: At present MRM cannot definitely distinguish between mastitis and inflammatory carcinoma, 80% of the inflammatory carcinomas were found to enhance more than 100% in the first minute, compared to 43% for mastitis. No other differences were seen. CONCLUSION: MRM proved useful in the follow-up of treated mastitis to demonstrate the success of antibiotic treatment of mastitis and to diagnose a histologically unconfirmed inflammatory carcinoma by means of a different follow-up.

Adenocarcinoma↗
PubMed1996

[Percutaneous therapy of malignant obstructive jaundice using expandable metal stents: a prospective study of 92 patients].

PURPOSE: To evaluate the clinical efficiency of percutaneously placed metallic stents in patients with malignant biliary obstruction. PATIENTS AND METHODS: In a prospective study 92 consecutive patients with malignant biliary obstruction were treated percutaneously with expandable metallic stents. Technical and clinical parameters during the procedure and regular follow-up were evaluated. RESULTS: Technical and clinical success rates were 100 and 91% respectively. During stent implantation we observed no severe complications. 30-day morbidity and mortality were 12 and 13% respectively. Late complications occurred in 35%, in 20.7% due to reocclusion of the bile ducts which was treated successfully in 17/19 patients. 75% of patients benefited from the procedure. Primary and secondary patency were 79.3 and 97.8%, respectively. CONCLUSIONS: Percutaneous transhepatic implantation of expandable metallic stents is a reliable and safe therapy for malignant jaundice and has a definite positive impact on the patients quality of life.

Adult↗
PubMed1996

[The diuresis urogram in patients with a bladder replacement].

PURPOSE: To differentiate between urodynamically relevant obstruction and functionally unimportant dilation of the upper urinary tract in patients with neobladder using a modified furosemide urogram. METHOD: An excretory urogram with furosemide loading was carried out in 19 patients with neobladder and sonographically and urographically confirmed dilation of the upper urinary tract. Once strong contrasting of the renal pelves and calyces has been achieved, 20 mg of furosemide were applied and late radiographs were obtained at 15 min and 30 min, respectively. An obstruction was defined as increasing dilation of the renal pelves and calices during forced diuresis and lack of washout effect of the contrast medium. RESULTS: In 32 cases, the renoureteral unit (RUU) was dilated on ultrasound. Of these, 25 RUU's showed good emptiness of contrast medium upon stimulation of diuresis, six RUU's returned a borderline findings, while one RUU was found to exhibit a decompensated anastomotic stenosis, which was dilated. Two further patients with borderline findings were later treated surgically due to their pain symptoms. No patient required further preoperative diagnostic procedures. CONCLUSIONS: The modified furosemide urogram represents a cost-effective diagnostic orientation strategy in patients with neobladder and dilated renal pelves and calyces and is both well-tolerated by patients and meets with broad acceptance from the urologic staff.

Adult↗
PubMed1996

Endovascular stenting in patients with Iliac compression syndrome. Experience in three cases.

The authors report their experience in the percutaneous treatment of the iliac compression syndrome in three women (20-53 years old) with acute iliofemoral deep venous thrombosis; in one case, there was an additional thrombus in the inferior caval vein. They were treated by percutaneous implantation of Palmaz stents in the left common iliac vein 1 day after surgical thrombectomy and construction of an arterial venous fistula. All patients showed marked improvement, as determined from venograms obtained immediately after stent implantation. The arteriovenous fistulae were closed 3 months later. At 6 months follow-up, the median clinical and color-coded duplex ultrasound indicates that all stents are patent and all patients are free of symptoms.

Adult↗
PubMed1996

Alveolar echinococcosis of the liver: percutaneous stent therapy in Budd-Chiari syndrome.

BACKGROUND AND AIMS: Infiltration of the hepatic veins in the alveolar echinococcosis can lead to the development of the Budd-Chiari syndrome. The medical and surgical treatment of this condition is generally unsatisfactory. The results of successful interventional treatment with percutaneous stent implantation in the hepatic veins are reported. METHODS: Using a transjugular approach, metal mesh stents (Boston Scientific, Medi-Tech Accuflex 8/60 mm) were placed in the median and left hepatic veins of a 53 year old woman. After the intervention, oral chemotherapy with albendazole (2 x 400 mg/day) was continued, but no anticoagulants were given. RESULTS: Stent placement was performed without complications. The clinical picture improved rapidly: normalisation of portal blood flow was confirmed by Doppler ultrasound and there was improvement of liver function, reduction of oesophageal varices, and disappearance of ascites. A follow-up examination at 15 months showed no evidence of stent occlusion. CONCLUSIONS: Treatment of portal hypertension in alveolar echinococcosis of the liver is problematic. In selected patients with portal hypertension secondary to hepatic vein stenoses but no cirrhosis, percutaneous stent placement in the hepatic veins represents a promising treatment alternative.

Albendazole↗
PubMed1996

CT-guided intraarterial chemotherapy in locally advanced tumors.

In a retrospective study, 123 patients with tumors (the majority were recurrent pelvic or breast neoplasms) underwent 376 cycles of intraarterial chemotherapy. Contrast material-enhanced computed tomography was performed to check the position of the catheter during 221 cycles. On the basis of findings, the catheter was repositioned 46 (20.8%) times because of weak contrast enhancement in the tumor region (n=24[10.9%]), involvement of neighboring healthy tissue (n=15[6.8%]), or both (n=7[3.2%]).

Antineoplastic Agents↗