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Biomedical subjects

J Hochberger

Publications and source records attributed to J Hochberger.

At least 37 records · Page 2Linked to original sources
PubMed1999

Endoscopic photodynamic diagnosis: oral aminolevulinic acid is a marker of GI cancer and dysplastic lesions.

BACKGROUND: Dysplasia and early cancer of the upper gastrointestinal (GI) tract often are undetected at white-light endoscopy. We describe oral administration of 5-aminolevulinic acid for the in vivo photodynamic diagnosis of premalignant and malignant lesions during endoscopy. METHODS: Four patients with known gastric adenoma (n = 1), macroscopically undetected but histologically proven esophageal squamous cell cancer (n = 1), suspected early cancer of the esophagus (n = 1), and multiple duodenal adenomas (n = 1) were sensitized with 5-aminolevulinic acid administered orally (15 mg/kg body weight). Photodynamic diagnosis was conducted after a retention time of 6 to 7 hours with a special light source capable of delivering either white or violet-blue light. Red fluorescence was detected through the gastroscope with an image-intensifying camera. RESULTS: All malignant lesions exhibited red or bluish fluorescence during photodynamic diagnosis. Fluorescence-negative mucosal areas proved to be histologically benign. CONCLUSION: Fluorescence induced with 5-aminolevulinic acid might be useful for the endoscopic detection of dysplasia and early carcinoma in the upper GI tract. Further investigations are needed to evaluate the sensitivity and specificity of photodynamic diagnosis for different tumor entities.

Adenoma↗
PubMed1999

Esophageal achalasia: intrasphincteric injection of botulinum toxin A versus balloon dilation.

BACKGROUND AND STUDY AIMS: In patients with esophageal achalasia, pneumatic dilation is the treatment of choice, but it bears the risk of perforation in about 4% of cases. A new nonsurgical method, intrasphincteric injection of botulinum toxin A, has shown promising initial results, and we thus undertook this study to compare the long-term outcome of these two methods. PATIENTS AND METHODS: In a prospective randomized study, 24 patients with definitive esophageal achalasia were divided into two equal groups and underwent either balloon dilation or injection of botulinum toxin (20 U injected into each of the four quadrants in the lower esophageal sphincter). The outcome was assessed on the basis of a symptom score documented before treatment and at regular intervals for two and a half years thereafter. Complications associated with the two techniques were also documented. RESULTS: No relevant complication occurred in either of the treatment groups. Initially, dilation was successful in 10 of 12 patients (83%), and botulinum toxin injection in 9 of 12 patients (75%). The symptom scores showed no significant differences between the two groups before and one month after treatment. Over the two and a half year follow-up, however, all nine successfully treated patients in the botulinum toxin group experienced recurrence of symptoms, but only four of the ten patients (40%) in the dilation group. CONCLUSIONS: The two treatment methods initially had equal success rates, but in the long term the effect of the botulinum toxin injection was statistically significantly shorter than that of balloon dilation. As fewer risks are associated with the injection treatment, studies should be undertaken either to identify patient subgroups in whom botulinum toxin can be effective long-term or to test substances with longer-lasting effects.

Adolescent↗
PubMed1998

Laser lithotripsy of difficult bile duct stones: results in 60 patients using a rhodamine 6G dye laser with optical stone tissue detection system.

INTRODUCTION: Laser lithotripsy of bile duct stones has become a widely accepted endoscopic treatment modality for giant, impacted, or very hard stones. The procedure is usually carried out under direct endoscopic control in view of the potential risk of bile duct injuries in "blind" laser application. AIMS: To investigate the use of a rhodamine 6G laser lithotriptor with an integrated optical stone tissue detection system (oSTDS). METHODS: From 1 September 1991 to 7 March 1997, 60 patients with giant or impacted common bile duct stones refractory to endoscopic papillotomy stone extraction, and mechanical lithotripsy were treated via the endoscopic retrograde route using a rhodamine 6G dye laser (595 nm, 2.5 micros, 80-150 mJ pp, Lithognost Telemit/Baasel Corp., Germany) with integrated oSTDS. In case of tissue contact oSTDS cuts off the laser pulse after 190 ns (transmission of 5-8% of the total pulse energy). 47 patients (78.3%) were subjected to x ray targeting (oSTDS) alone, five (8.3%) to choledochoscope targeting alone, and eight (13.3%) to both techniques. RESULTS: At the end of treatment 52 (87%) patients were completely stone-free. The only major complications included transient haemobilia, cholangitis, and pancreatitis in five patients. All five were successfully treated by conservative methods. CONCLUSIONS: Laser lithotripsy using the described rhodamine 6G dye laser with oSTDS seems to be safe and effective and allows "blind" fragmentation of difficult common bile duct stones under radiological control only.

Adult↗
PubMed1998

[Disposable protection for flexible gastroenterologic endoscopy: prospective comparative evaluation of a new gastroscopy system (Endosheath) compared to the standard fiberglass gastroscope].

The reprocessing of flexible gastrointestinal endoscopes is time-consuming and expensive. Endoscopically transmitted infections due to insufficient disinfection are already of clinical importance. A new developed prototype of a flexible, fiberoptic gastroscope was tested in a prospective open randomized trial to evaluate the function. reprocessing and hygienical safety of this disposable, sheathed endoscopic system and was compared with a standard gastroscope. This new endoscopical system utilizes a disposable sheath to cover and protect all working surfaces of the endoscope from contamination. A prospective, randomized trial was performed in our unit to compare the disposable gastroscope (G-F100) with a standard-gastroscope of the newest Generation (GIF-Q 30). Visual analog rating scales were used to record evaluations of endoscope performance and reprocessing by endoscopists and reprocessing personnel. We recorded the time of reprocessing, the time to perform the procedures, depth of insertion, total instrument downtime and any problems which occurred during the procedure. Microbiological swabs were taken from each endoscope. 40 procedures (20 standard, 20 sheathed) were performed. The sheathed gastroscope 8.9 min versus 7.1 min. The overall instrument downtime was significantly shortened by the endosheath (9.8 min versus 47.5 min with the standard gastroscope). The disposable gastroscope-system permits an increase of procedure-frequency up to a factor of 2.9. The standard gastroscope was preferred by the endoscopists and the reprocessing personnel. No microbiological contaminations of the sheathed or the standard gastroscopes could be demonstrated, and no leak of the sheaths was recorded after gastroscopy. The disposable gastroscope has important advantages of decreased instrument turn-around time and potentially increased staff and patient safety.

Gastroscopes↗
PubMed1995

Effect of colonoscopy premedication containing diazepam and pethidine on the release of mast cell mediators in gut mucosal samples.

BACKGROUND AND STUDY AIMS: To date there is no information available on whether drugs that are commonly used in premedication for colonoscopy procedures, such as diazepam and pethidine, may activate intestinal mast cells and thereby give rise to adverse effects. Since opioids such as pethidine are well-known for their ability to induce histamine release from several mast cell subtypes, the present study investigated the effect of diazepam and pethidine, intravenously administered as premedication for colonoscopy, on mast cell mediator secretion from colonic and rectal mucosa. PATIENTS AND METHODS: The secretion of the mast cell mediators histamine and tryptase was followed from biopsies of patients with and without premedication for 30 minutes in an air-bubbled incubation medium (mucosa oxygenation). The mediator release and tissue histamine content were studied prospectively in 17 control persons (histologically normal mucosa) as well as in 71 patients with inflammatory bowel disease (IBD) (histologically uninvolved and involved tissue). RESULTS: Although a significant accumulation of histamine was found in inflamed IBD-tissue, the results indicate, however, that this premedication does not enhance the release of histamine or tryptase from gut mucosal samples, neither in the histologically normal mucosa of control persons nor in tissue unaffected or affected by inflammatory bowel disease. CONCLUSION: This study demonstrates that colonoscopy premedication with diazepam and pethidine is safe in terms of gut mucosal mast cell activation.

Adult↗
PubMed1995

Memory metal stents for palliation of malignant obstruction of the oesophagus and cardia.

Thirty patients with incurable malignant obstruction of the oesophagus and cardia were treated with self expanding oesophageal memory metal stents (Ultraflex) in a prospective study. The endoprostheses were successfully placed in all patients. Within one week after implantation dysphagia had improved in 25 of 30 patients (83%). Stent expansion was incomplete within one week after implantation in 12 of 30 patients (40%). After an average of two dilatation sessions eight of 12 stents had expanded completely. Five patients complained of retrosternal pain and three of them suffered from heartburn over several days despite acid inhibition. Major problems in the follow up period occurred in 10 of 30 patients (30%) and included late perforation (one) and tumour ingrowth/overgrowth (nine). All of these complications were treated endoscopically. Improvement of the dysphagia of the patients with tumour ingrowth/overgrowth lasted for about eight weeks (median; range: 2-38 weeks). Until November 1994 six of 30 patients were still alive with a survival time of 309 days (median; range: 103-368 days). It is concluded that oesophageal memory metal stents are easy to implant, prove effective in the palliation of malignant oesophageal obstructions, and have a low risk of severe complications. The only disadvantages are that incomplete initial stent expansion as well as tumour ingrowth/overgrowth occurred in nearly one third of the patients.

Adenocarcinoma↗