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Biomedical subjects

J F Riemann

Publications and source records attributed to J F Riemann.

At least 19 recordsLinked to original sources
PubMed1992

[Hemosuccus pancreaticus due to a pressure ulcer in pancreatolithiasis].

Ultrasound examination in a 32-year-old man with epigastric pain and slightly elevated serum amylase level (66 U/l) revealed cysts in the head and tail of the pancreas as well as nonhomogeneous pancreas parenchyma as signs of chronic pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) additionally showed pancreatolithiasis. Melena occurred 7 months later, haemoglobin concentration decreasing to 8.7 g/dl. Endoscopy revealed bleeding into the duodenum via the papilla major. Angiography excluded vessel rupture. Haemostasis was achieved by occlusion of the pancreatic duct with fibrin glue, but the procedure had to be repeated twice within the next 8 months. Three months later ERCP was performed because of melena with massive haematemesis (haemoglobin level 6.5 g/dl). Stones were no longer demonstrated. At the previous location a pressure ulcer was now demonstrated, together with fresh blood in the pancreatic duct. After the stones had passed the ulcer healed and the patient has been symptom-free for over 13 months.

Adult↗
PubMed1992

[Ménétrier's disease--a rare cause of a protein deficiency syndrome].

Hypoproteinaemia (total proteins 5.2 g/dl) and hypoalbuminaemia (2.7 g/dl) were demonstrated in a 44-year-old woman with leg oedema during the previous four months and 10-kg weight gain during the previous year. A protein-losing enteropathy was diagnosed, all other causes having been excluded. Gastroscopy revealed giant hypertrophic gastritis. A biopsy showed foveolar hyperplasia with some inflammatory infiltrates, typical of Ménétrier's disease. Endosonography excluded any additional infiltrative process of the bowel wall. Long-term treatment with ranitidine, 150 g twice daily, achieved normalization of total protein and albumin concentrations. But the macroscopic changes in the gastric wall were still recognizable on repeat gastroscopy. As there is a danger of malignant degeneration gastroscopy and, if indicated, endosonography should be repeated annually.

Adult↗
PubMed1992

[Shockwave treatment of gallbladder stones. Current status of therapy].

AIMS: Analysis of the results of piezoelectric lithotripsy of gallstones combined with subsequent dissolution therapy using chenodeoxycholic acid and ursodeoxycholic acid. DESIGN OF STUDY: Retrospective evaluation after 2 1/2 years application in the department; prospective study for stone recurrence with ASA. PATIENTS: A total of 246 patients with gallbladder stones selected on the basis of the Munich criteria; 171 patients were followed up for at least 24 months. RESULTS: With piezoelectric shockwave lithotripsy treatment can mostly be carried out without the need for analgesia. When the indication is strictly applied, a stone-free rate of almost 90% after one year can be achieved. To achieve this, regular use of bile acids for dissolution of the fragments remaining after lithotripsy is required. At the present time, our recurrence rate is around 14% after one and two years. The use of acetylsalicylic acid recurrent stone prophylaxis was of no benefit. CONCLUSIONS: Extracorporeal shockwave lithotripsy now forms a permanent part of the conservative therapeutic approach to cholecystolithiasis. The results obtained are largely dependent upon an accurate indication. Particularly suitable patients are those with solitary cholesterol stones in a properly functioning gallbladder.

Adult↗
PubMed1992

Intraductal shock-wave lithotripsy in complicated common bile duct stones.

Intracorporeal shockwave lithotripsy was performed in 36 patients with problematic common bile duct stones. All of the patients had undergone unsuccessful mechanical lithotripsy prior to this procedure. In 29 patients (80.6%), the stones were fragmented under cholangioscopic control and subsequently extracted with a Dormia basket. In seven patients, the procedure failed due to stone impaction or failure to intubate the common bile duct with a nasobiliary tube. No complications were observed. Cholangioscopically guided intracorporeal shockwave lithotripsy is a highly effective and safe procedure for the conservative treatment of complicated common bile duct stones.

Aged↗
PubMed1992

Extracorporeal piezoelectric lithotripsy for retained bile duct stones.

Extracorporeal piezoelectric shock wave lithotripsy (EPL) was performed in 35 patients with endoscopically non-extractable stones. With this lithotripter, stones are visualized by ultrasound and shock waves are produced by a piezoelectric acoustic generator. The stones could be localized in 32 out of 35 patients. Fragmentation was achieved in 91.4% and complete stone removal in 77.1%. These results show that piezoelectric lithotripsy is also a useful method for the treatment of complicated bile duct stones, as already demonstrated for the electrohydraulically and electromagnetically generated shock waves systems. The piezoelectric system is especially useful in elderly and frail patients because no general anesthesia is needed and only 14% of cases require analgesia or sedation.

Aged↗
PubMed1992

[Significance of the ulcer vessel in acute ulcer hemorrhage--value of local endoscopic therapy in combination with endoscopic Doppler ultrasound].

The acute ulcer hemorrhage is one of the most frequent diagnoses in Gastroenterology. In addition to the active hemorrhage the visible ulcer vessel, even if not bleeding at present, is one of the most important prognostic criteria. Numerous controlled studies have shown that with this sign recurrent hemorrhages will occur in up to 81%, resulting in emergency surgery in up to 56% with an associated mortality of up to 21%. By a meta-analysis we could show that prophylactic endoscopic therapy can significantly reduce both the rate of recurrent hemorrhage as well as emergency surgery. If the endoscopic doppler is used as well, as diagnostic as well as follow-up examination, the effectiveness of endoscopic treatment is greatly improved. The numbers we present show that active local endoscopic therapy should be undertaken in a visible ulcer vessel.

Arteries↗
PubMed1992

[Extracorporeal shockwave lithotripsy of gallstones. Retrospective view and perspectives].

Extracorporeal shock-wave lithotripsy (ESWL) is a non-invasive technique in gallstone management, which has been in clinical use since many years now. Exact patient selection provides considerable stone-free rates within a year. Side effects and complications are rare. The stone-recurrence rate is about 15% after two years, and thus lower compared to that after oral dissolution therapy alone. Until now, there is no reasonable medical therapy to prevent stone recurrence. Furthermore, ESWL is a suitable therapy for retained common bile duct stones. Although laparoscopic cholecystectomy has become established as a new, minimally invasive surgical method, ESWL will continue to be a successful technique for the treatment of thoroughly selected gallstone patients, who are looking for a non-invasive way to get rid of their biliary pain, but not of their gall bladder.

Chenodeoxycholic Acid↗
PubMed1992

[Solitary angiomyolipoma of the liver].

Today in the age of ultrasonography focal hepatic lesions are diagnosed more often, which are difficult to be classified. Metastases are leading numerically among the malignant tumors, hemangiomas among the benign. We report on a rare case of a hemangiomyolipoma of the liver and the diagnostic difficulties. The final diagnosis was made only after hemihepatectomy.

Adult↗
PubMed1992

[Stomach wall abscess--endoscopic diagnosis and therapeutic possibilities].

This is a case report of a rare gastric wall abscess of a 70 year-old woman who came to hospital with non-characteristic pain in the upper abdomen. The diagnosis was made by endoscopy. After endosonography the patient was treated by endoscopic drainage, antibiotics and abstinence of food. Two weeks later the abscess had healed. Subsequently recurrent arterial emboli occurred in the left leg leading to several operations. Two months after hospitalisation the woman died as a result of circulation failure induced by septicaemia. Surprisingly, post mortem examination showed endocarditis of the mitral valve with septical metastases in multiple organs. A review of the literature is given and etiology and pathogenesis of the gastric wall abscess are reviewed. The surgical treatment is compared with endoscopic therapy.

Abscess↗
PubMed1991

[Lye corrosion of the esophagus. Course under long-term bougienage].

In an alcoholic state a 61-year-old woman swallowed by mistake about 125 ml of a lye-containing glass-washing liquid (pH 12). About 30 min later she repeatedly brought up blood-containing vomitus and was admitted to hospital. Extensive corrosive damage in the oesophagus and entire stomach developed within a few days. Two weeks later a circular narrowing of the oesophageal lumen, which could not be passed endoscopically, was seen. Afterwards she repeatedly underwent endoscopic bougie dilatation. At the third dilatation the oesophagus was perforated, mediastinitis occurred but responded without further problems to conservative medical treatment. Two months after the initial injury a Billroth II gastric resection was performed because of complete stenosis of the gastric exit. Bougie dilatation was continued at widening intervals for 18 months after the ingestion. Subsequently the patient has remained without symptoms, although a secondary Barrett oesophagus has developed at the oesophago-gastric junction which, because of the potential danger of malignant degeneration, will require regular follow-up.

Accidents, Home↗
PubMed1991

[Esophageal motility disorders with thoracic pain of unknown origin].

35 patients with angina-like chest pain underwent esophageal manometry after a coronary artery disease had been ruled out by angiography. Furthermore, patients after gastric or esophageal surgery, with pathologic upper gastrointestinal endoscopy or with pathologic gastroesophageal reflux as seen on 24-hour-pH-metry were excluded from this study. 29 out of 35 patients (83%) had a normal manometric study, six patients (17%) had a motility disorder; five of these showed an unspecific dismotility pattern and were asymptomatic while the study was done; only one patient presented with esophageal spasm. Since only this latter patient was symptomatic while the study was done, a correlation between symptoms and this motility disorder seems likely. --If pathologic gastroesophageal reflux has been ruled out, esophageal manometry can establish a diagnosis in only 3% of patients with angina-like chest pain without esophageal symptoms (dysphagia, odynophagia, heartburn or regurgitation). We conclude that this complicated examination should not be done in these patients.

Adult↗
PubMed1991

[Diagnosis of rare causes of upper gastrointestinal tract bleeding].

Possible errors in diagnosing rare sources of bleeding were analysed in 433 consecutive patients examined for upper gastrointestinal bleeding between May 1987 and June 1990. Rare lesions not necessarily recognizable as sources of bleeding were found in 14 patients (8 women and 6 men; mean age 66 [46-82] years). In 9 of the 14 the lesion was above the ligament of Treitz and thus accessible to routine esophagogastroduodenoscopy. Nonetheless, in 4 of these 9 cases the source of bleeding was not recognized at the first gastroscopy. They were all lesion in the region of the horizontal duodenum or Treitz's ligament (3 duodenal carcinomas, 1 aortoduodenal fistula). This finding indicates that, if the deep duodenum cannot be assessed with certainty in the initial gastroduodenoscopy, the region should be selectively studied endoscopically or radiologically before more invasive examinations are undertaken. In the remaining 5 of the 14 patients the source of bleeding was distal to Treitz's ligament. After the usual diagnostic tests (esophagogastroduodenoscopy, coloscopy, small intestine double-contrast imaging, angiography, scintigraphy) the sources of bleeding (angiodysplasias, jejunitis, enteritis) were confirmed in four patients by intraoperative ileo-jejunoscopy. In three of the latter cases bleeding did not recur after operative intervention, in one patient with multiple angiodysplasias severe bleeding recurred immediately after operation.

Aged↗
PubMed1991

Piezoelectric lithotripsy in the treatment of symptomatic gallstone patients. A 12-month follow-up.

Between January and May 1989, 65 patients with symptomatic gallbladder stones were treated with extracorporeal piezoelectric lithotripsy (EPL) and supplementary dissolution therapy with oral bile acids. In 98% of the patients, fragmentation of stones was achieved. On average, each patient received 3.18 treatments. In addition to attacks of colic and asymptomatic changes in laboratory parameters, one hematoma of the gallbladder and one of the liver were observed, together with pancreatitis and cholecystitis in two patients each. During the follow-up period, three patients developed symptomatic bile duct stones. An endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy was performed on four occasions, while one female patient had to undergo urgent cholecystectomy for inflammation of the gallbladder and empyema. Six months after the initial treatment, 36 (55%) patients were free of stones, while the stone-free rate after 12 months was 64.5% (41 of 65). Ninety percent of the patients with a solitary stone less than or equal to 2 cm in diameter became stonefree within a year. Extracorporeal piezoelectric lithotripsy is clearly a feasible procedure for the treatment of certain gallstone patients.

Adult↗