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Biomedical subjects

J Fritsch

Publications and source records attributed to J Fritsch.

At least 91 records · Page 5Linked to original sources
PubMed1992

[Colorectal villous tumors. Treatment by electro-resection and laser photocoagulation. 134 cases].

Endoscopic snare resection prior to Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenoma. One hundred and thirty four patients were included in the study: 72 with surgical contraindications, 61 for whom surgical resection appeared to be too drastic and 1 who refused surgery. Treatment sessions were repeated every fifteen days until total tumour destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of seven patients. Eight patients were lost to follow up. Treatment results could be analysed in 119 patients. A successful treatment was achieved in 108 patients. Tumour destruction was complete in 85.4 percent of the cases with lesions of at least 4 cm in diameter and in 94.3 percent of the cases with smaller lesions. During the average 101 weeks follow up period, 15.7 percent of the patients with total tumour destruction had recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgical treatment. It would appear that endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method for the destruction of colorectal villous adenomas.

Aged↗
PubMed1992

Management of malignant hilar biliary obstruction by endoscopy. Results and prognostic factors.

Between January 1983 and December 1987, 103 patients who had hilar biliary obstruction (59 men, 44 women, median age 73 years) were referred to our institution. The causes of hilar biliary obstruction were carcinoma of the bile ducts (55), hepatic metastases or hepatocellular carcinoma (30), and carcinoma of the gallbladder (18). When endoscopic retrograde cholangiography was performed, the stricture was classified as type I in 28%, type II in 41%, and type III in 31% of the patients. In 92 patients, we tried to insert endoscopically a 10, 11, or 12 F Amsterdam type prosthesis; it proved possible in 66 (74%), and the prosthesis proved functional without further procedure in 49 cases (53%); no combined percutaneous and endoscopic method was used. At death or discharge, 45 patients (49%) had a successful drainage. Cholangitis was the main procedure-related complication and occurred in 25 patients. The 30-day mortality was 43%. Results varied according to type of stenosis: successful drainage was performed in 15% of the patients with type III stenosis, compared with 86% when the stenosis was of type I. Under a multivariate analysis the independent prognostic factors of 30-day mortality were: (1) development of infectious complications after endoscopic attempt at drainage (P less than 0.0001), and (2) absence of successful drainage (P less than 0.0001). In conclusion, endoscopic endoprosthesis placement allows a sufficient drainage in 53% of the cases. In type III stenosis, the high rate of 30-day mortality leads us the conclusion that endoscopic drainage must be avoided.

Adult↗
PubMed1992

Association of juxtapapillary diverticula with choledocholithiasis but not with cholecystolithiasis.

Juxtapapillary diverticula are often associated with biliary lithiasis. The aim of this study was to compare the prevalence of juxtapapillary diverticula in choledocholithiasis and in cholecystolithiasis without common bile duct stones. The results of 520 consecutive retrograde cholangiographies were retrospectively analysed. The prevalence of juxtapapillary diverticula was higher in patients with biliary lithiasis than in patients without: 26.0% vs 10.5% (p less than 0.001). However, juxtapapillary diverticula were more frequently encountered in patients with choledocholithiasis than in those with gallbladder lithiasis or previous cholecystectomy and a stone-free common bile duct: 40.0% vs 10.2% (p less than 0.001). There was no significant difference between the patients with cholecystolithiasis alone and those without biliary lithiasis. Among the patients with previous cholecystectomy or with gallbladder lithiasis, common bile duct stones were more frequently found in patients with juxtapapillary diverticula than in those without: 80.3% vs 40.6% (p less than 0.001). These data suggest that juxtapapillary diverticula are associated only with choledocholithiasis and not with gallbladder lithiasis.

Aged↗
PubMed1992

[Extracorporeal lithotripsy in the treatment of common bile duct calculi].

Thirty-three patients with common bile duct stones which could not be extracted by routine endoscopic measures were treated with extracorporeal lithotripsy. Two electrohydraulic lithotripters were used: Dornier HM3 and Technomed Sonolith 3000 using fluoroscopy and ultrasonography, respectively, for stone localisation. Twenty-nine patients were treated with only one session and four patients in two sessions. Fragmentation of stones was obtained in 29 patients (88 p. 100) and complete bile duct clearence in 26 patients (79 p. 100). The fragments passes spontaneously through the papilla in 7 cases; in 19 cases complete removal of fragments was achieved with a Dormia basket (16 cases) or after mechanical lithotripsy (3 cases). There were no significant differences in successful fragmentation rates between the two lithotriters. No serious adverse effects or mortality were observed within the 30 days following treatment. In conclusion, extracorporeal lithotripsy is an effective and safe method for the treatment of bile duct stones when, after sphincterotomy, routine endoscopic measures have failed.

Adult↗
PubMed1991

Endoscopic treatment by snare electrocoagulation prior to Nd:YAG laser photocoagulation in 85 voluminous colorectal villous adenomas.

The association of endoscopic resection with Nd:YAG laser photocoagulation was used to treat benign colorectal villous adenomas. Eight-five patients were included: 49 with surgical contraindications, 35 for whom surgical resection appeared to be too hazardous, and 1 who refused surgery. Forty-five tumors had an axial extension between 1 and 3 cm, and 40 tumors had an axial extension of at least 4 cm. Diathermic snare resection was performed to remove large tumoral fragments prior to laser photocoagulation of the residual flat lesions. Treatments were repeated every 15 days until total tumor destruction was achieved. A carcinoma was detected in biopsy specimens obtained during endoscopic treatment of five patients. Two patients were lost to follow-up. Treatment results could be analyzed in 78 patients. Successful treatment was achieved in 67 patients. Tumor destruction was complete in 77 percent of patients who had lesions of at least 4 cm diameter and in 93 percent of patients with smaller lesions. The axial extension of the tumor was the main factor affecting the results of treatment. No major complications occurred. During the average 103-week follow-up period, 21 percent of the patients with total tumor destruction had a recurrence. The risk of recurrence was correlated with the number of initial treatment sessions and previous surgery treatment. It would appear that the treatment with endoscopic resection prior to Nd:YAG laser photocoagulation is a safe and effective method in the destruction of colorectal villous adenomas.

Adenoma↗
PubMed1990

Endorectal sonography in the management of rectal villous tumours.

Thirty-seven patients with rectal villous tumours were investigated by endorectal sonography to assess the integrity of the rectal muscularis propria at the tumour level. In four cases assessment of invasion was impossible. In 24 patients, endosonography revealed an ultrasonically superficial lesion not infiltrating the muscular layer. This was confirmed either, in the case of laser treatment, by the absence of malignant recurrence during the follow-up period or by histological examination after surgical resection. In nine patients, endosonography showed infiltration of the muscular layer. This was histologically confirmed in five operated patients. In the remaining four, laser destruction was performed: in two, a rectal adenocarcinoma was present 3 and 6 months later, respectively. These findings show that endosonography has a place in the management of rectal villous tumours, demonstrating invasive cancer in cases where other forms of assessment were wrongly reassuring.

Adenocarcinoma↗
PubMed1990

[Obstructive icterus in patients with hepatic tumor. Result of non-surgical biliary drainage].

Seventeen patients with biliary obstruction and hepatic tumors were treated by endoscopic or percutaneous transhepatic drainage with an endoprothesis. There were 9 men and 8 women (mean age = 61 +/- 13 years). Four patients had primary hepatic carcinoma and 13 had hepatic metastases. Decrease of serum bilirubin of more than 75 percent was achieved in 12 of the patients (71 percent). The success rate was related to the level of the biliary obstacle and not to the importance of hepatic parenchymal involvement. Failure was significantly more frequent (p = 0.003) in patients with type III hilar strictures compared to the other patients with pedicular or type I and II hilar strictures. Cholangitis was the major complication (29 percent) and occurred only in the patients with type III hilar strictures. Mortality was 24 percent at 30 days. This rate was 57 percent in the group of patients with type III hilar strictures and significantly higher (p = 0.015) than other patients. Cumulative survival was better in patients with relief of jaundice than that observed in the other patients (p less than 0.01). Two patients with metastatic carcinoma of the breast treated by chemotherapy survived more than 20 months without jaundice. Analysis of these data indicates that in patients with hepatic tumors and obstructive jaundice, palliative treatment with endoprothesis can provide relief of jaundice and that prolonged survival may be observed in patients with chemosensible tumors.

Aged↗
PubMed1989

Chloride current activated by cyclic AMP and parathyroid hormone in rat osteoblasts.

In primary cultures of rat osteoblasts, studied with the whole-cell configuration of the patch-clamp technique, 8-bromo-cyclic AMP (8BrcAMP) forskolin (FS) and 1-34 parathyroid hormone (PTH) were shown to activate a Cl conductance. This conductance shows a pronounced outward rectification, even with symmetrical Cl concentrations. It is blocked partially and reversibly by 4,4'-diisothiocyanatostilbene 2,2'-disulfonic acid (DIDS) or diphenylcarboxylate (DPC). The blockade induced by DIDS is time- and voltage-dependent. The Cl responses to FS and PTH develop slowly, after a delay of several seconds and are very slowly reversible. These responses were observed only in a fraction of the cells tested and their detection was favoured by cell dialysis. This Cl current should be taken into account for studying possible modulations of the voltage-gated Ca currents of osteoblasts. It is suggested that its physiological role may be related to the well-known morphological changes induced by PTH in osteoblasts. The cyclic AMP-sensitivity, the outward rectification and the sensitivity to dialysis of this Cl current are reminiscent of the properties of the cystic fibrosis-sensitive Cl channels of epithelial cells.

4,4'-Diisothiocyanostilbene-2,2'-Disulfonic Acid↗
PubMed1989

Corticosteroid-induced changes in the responsiveness of human osteoblast-like cells to parathyroid hormone.

We investigated the in vitro effect of corticosteroids on the responsiveness of human cells of osteoblast lineage to parathyroid hormone (PTH). Prior to corticosteroid treatment, the cells demonstrated only a small increase in cAMP production and no measurable change in transmembrane potential in response to PTH. Exposure of cells to dexamethasone resulted in a 5-fold increase in PTH-induced cAMP production and in measurable PTH-induced membrane depolarization in all cells studied. The effect of corticosteroids on cAMP production was specific for PTH (not seen with PGE1 or forskolin), occurred in a time- and dose-dependent fashion and in the absence of cell proliferation. Most of the cells were of osteoblast lineage as determined by the presence of alkaline phosphatase activity and BGP secretion. These findings further support the idea that corticosteroids increase the sensitivity of cells of osteoblast lineage to PTH, perhaps by transforming cells which initially have a low responsiveness to PTH to a state of high responsiveness.

Adolescent↗
PubMed1988

[Prevention of hemorrhagic recurrence in cirrhotic patients. Is sclerotherapy better than propranolol?].

The effectiveness of oral propranolol and sclerotherapy in preventing recurrent bleeding after an endoscopically proven haemorrhage from oesophageal varices was compared in Pugh's grade B and C patients divided into two successive therapeutic groups. Group I patients (n = 32) were given oral propranolol, while sclerotherapy was performed in group II patients (n = 32), 23 of whom simultaneously received propranolol. There was no difference between groups I and II in the severity of the initial bleeding and liver failure (Groups I/II, B 19/18, C 13/14), in the withdrawal of alcohol (group I 25, group II 17) and in compliance with either treatment (group I 25, group II 27). Obliteration of the oesophageal varices was achieved in 69 p. 100 of group II patients within a median number of 4 courses and 46 days, and in 84 p. 100 of the patients of this group who survived for more than 3 months. One year after the beginning of treatment rebleeding had occurred in 43 p. 100 of either group I or group II patients. The 1-year survival rate was 72 p. 100 in group I and 62 p. 100 in group II (non significant). The causes of death were the same in both groups. Irrespective of the treatment assigned, death was 2.1 times more frequent (P = 0.02) and rebleeding was 1.2 time more frequent (P = 0.08) in grade C than in grade B patients.

Esophageal and Gastric Varices↗
PubMed1988

Early effects of parathyroid hormone on membrane potential of rat osteoblasts in culture: role of cAMP and Ca2+.

Microelectrodes were used to investigate the possible involvement of cAMP and Ca2+ ions in the parathyroid hormone's, bPTH(1-34), effect on the membrane potential of rat osteoblasts in primary culture. Parathyroid hormone (10(-7) M) depolarized cell membrane by 25.0 +/- 6.1 mV (mean +/- standard deviation, SD; n = 17). Blocking Ca2+ influx with the Ca channel blocker cobalt revealed two phases in the hormone effect: a rapid and slight membrane hyperpolarization followed by sustained depolarization. In addition, cobalt significantly (p less than 0.01) decreased the magnitude of the PTH depolarizing action. The addition of dibutyryl-cAMP (10(-3) M) to the perfusion solution also resulted in a biphasic effect. At a lower concentration (10(-4) M), dibutyryl-cAMP produced only membrane hyperpolarization, suggesting a cAMP dose dependence of the opposite membrane potential changes. Forskolin (10(-5) M) and the phosphodiesterase inhibitor isobutylmethylxanthine (IBMX) (10(-4) M) mimicked the depolarizing effect of PTH. IBMX at a low concentration (5 x 10(-6) M) potentiated the depolarizing effect of PTH. Increases in [Ca2+]i using Ca2+ ionophore A23187 and intracellular injection of CaCl2 or inositol trisphosphate decreased the PTH depolarizing action, whereas intracellular injection of EGTA enhanced this effect. These results indicate that PTH evokes a biphasic change in rat osteoblast membrane potential that seems to be mediated by an increase in cAMP and modulated by intracellular calcium.

1-Methyl-3-isobutylxanthine↗