[[The so-called postcholecystectomy syndrome in the light of endoscopic studies].
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Biomedical subjects
Publications and source records attributed to J Papp.
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The clinical and pathogenetic features of pancreas divisum are surveyed on the basis of ERCP examination. This congenital anomaly of the pancreas can be distinguished from ductal obstruction on the basis of the radiographic configuration. In such patients the parenchyma of the pancreas can be properly evaluated only if the dorsal and ventral pancreatic ducts are visualized simultaneously. Pancreas divisum may be regarded as imposing an increased risk of supervening pancreatic diseases.
Endoscopic papillotomy (EPT) was performed in 66 patients, 59 of whom had choledocholithiasis and the remaining seven had stenosis of the papilla of Vater. The stones passed spontaneously in 37 patients, but had to be extracted in 10 cases. All seven patients with stenosis showed free bile flow following EPT. Four patients become anicteric although the stones persisted. Four patients had a febrile complication which subsided in response to antibiotic therapy.
The clinical data of two patients are reported at whom after endoscopic retrograde cholangiography (ERC) acute pancreatitis has evolved. In the development of this acute pancreatitis the membrane rupture and parenchymography do not play a role, however the duct of Wirsungian did not fill with contrast material. The pathogenesis of complications and the possibilities of prophylaxis are described.
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The endoscopic retrograde cholangiopancreatography (ERCP) findings in 30 patients with chronic pancreatitis and 25 cases of pancreatic cancer are presented in this report. The diagnosis was confirmed in every case by surgery or at autopsy. ERCP was found to be a reliable means of differentiating between pancreatic cancer and chronic pancreatitis in most cases. Multiple lesions are typical of chronic pancreatitis. In solitary lesions a diagnosis can be reached only by consideration of the pancreatographic findings in conjunction with the clinical picture.
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Features of 75 abnormal pancreatograms are analysed. Radiomorphology is conferred with surgical or postmortem findings in all cases. None of the anatomical alterations was found to be specific for any given diseases entity, some consistency was verified however. Solitary stenosis suggests cancer. Diffuse alterations point to chronic pancreatitis. Cave filling is a likely sign of cyst or pseudocyst. Since, however, these features are nonspecific, the diagnosis must be based on clinical data as well.
During 33 months in 45 patients 52 times an endoscopic polypectomy was performed in the stomach or in the duodenum. The polyp or the polyposis of the stomach in every case should be clarified with the help of endoscopic polypectomy and histological examination. The histological type of the polyps got in toto determines the therapeutic methods essentially deviating from each other. After a polypectomy a regular gastroscopic control is necessary. The 10% frequency of postoperative bleedings after endoscopic polypectomy may be reduced by improvement of the technique.
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A patient with Caroli's syndrome is reported; diagnosis was made by ERCP and ultrasonography. Caroli's disease occurred in its "pure" form in this patient, i.e. dilatation was present only in the intrahepatic biliary system while the extrahepatic bile ducts were normal. Pathogenesis and differential diagnosis are surveyed on the basis of available data. Further, the possibilities of treatment and prognosis are dealt with.
Portal hypertension is found in about one quarter of the cases with upper gastrointestinal bleeding. 57 patients with portal hypertension underwent endoscopy for gastrointestinal haemorrhage. Despite visible varices in all cases varice rupture underlies only 50% of the bleeding episodes. Conditions other than rupture were found to bleed in 50%. Superficial mucosal erosions, which escape radiological detection, were the most frequent other bleeding sources.
A wide range of enzymes was investigated following endoscopic retrograde cholangio-pancreatographie ERCP/. Of the 12 enzymes studied highly significant increase of levels were seen in amylase /AML/ and lipase /LIP/ activities. Increase in the other 13 enzymes were slight and failed to persist for 40 hours. The incidence rate of a subclinical pancreatitis-like disorder is high, but typical acute pancreatitis is rare. Likely post-ERCP complications must not be disregarded, however, in selecting patients for ERCP.