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J Schoenemann

Publications and source records attributed to J Schoenemann.

At least 19 recordsLinked to original sources
PubMed2000

[Cholinergic syndrome with unconsciousness in amanita poisoning].

HISTORY AND ADMISSION FINDINGS: A 41-year-old patient was found in his flat in a state of coma. After emergency treatment his vital signs were stable and he was transferred to an acute hospital with possible cannabis intoxication. The patient, a hobby gardener, was previously well and had an adversion to the use of any chemical substances. The main symptom showed a cholinergic syndrome with deep coma. We assumed plant ingestion because of the clinical picture and history. INVESTIGATIONS: The laboratory results were within normal limits apart from a slight rise of the serum creatinine kinase level. The electrocardiogram showed a bradycardia. A drug-screening could not be performed. TREATMENT AND COURSE: The differential diagnosis of plant alkaloids or mushroom toxins were considered due to possible plant ingestion and a cholinergic syndrome. Later the toadstool (Amanita muscaria) was found. After treatment oft the cholinergic syndrome with high doses of atropine primary poison elimination was performed. 24 hours later the patient awoke from his coma. Visual hallucinations persisted for a few days. No organic damage due to the intoxication was found. CONCLUSION: Toxic mushroom ingestion can produce a variety of clinical pictures. Most commonly an anticholinergic syndrome is found, but this was not the case in this patient. The effect of the poison depends on the amount and the preparation, so that no reliable outcome prediction can be made. The drug "poisonous mushroom" is legal and hallucinogenic substances are trendy. As a result clinical signs like those described here will have to be expected in the future.

Adult↗
PubMed2000

[Pneumopericardium and retroperitoneal and scrotal emphysema after endoscopic papillotomy].

Retroduodenal perforation is considered a rare but serious complication of endoscopic papillotomy. We report on a patient suffering from a stenotic occlusion of the ductus hepatico-choledochus on whom a pre-cut via needle-knife was performed in order to place a stent. Hours after the procedure, the patient developed an extensive pneumoretroperitoneum, pneumopericardium and scrotal emphysema. The later have not been reported in relevant literature so far.

Cholestasis, Extrahepatic↗
PubMed1998

[Unwanted drug effects in clinical practice].

BACKGROUND AND OBJECTIVE: Unwanted drug reactions (UDR) in routine clinical practice remain largely unrecorded, even though such documentation can significantly contribute to quality assurance in drug therapy. This prospective study was undertaken to ascertain within a defined time period the frequency and significance of UDR in the medical wards of a general hospital (focus on gastroenterology) and find the organisational structures needed for its documentation. PATIENTS AND METHODS: All observed UDRs among a total of 4032 in-patients were recorded on a simple registration form, filled in by doctors assigned to collect the information, which was then analysed in cooperation with the Drug Commission of the German Medical Council (AKdA). RESULTS: UDRs were recorded in 315 patients (7.8%), 135 of them (43%) already present on admission. 101 patients had been admitted because of the UDR. Gastrointestinal disorders, particularly peptic ulcer, and skin rash were the most common UDRs. Individual drugs most frequently responsible were acetylsalicylic acid, cyclophosphamide and digoxin, the most common drug groups were nonsteroid analgesics, antibiotics and cytostatic drugs. The method employed proved to be practicable and cost-effective. CONCLUSIONS: A simple and cost-effective system, integrated into the daily medical routine, can heighten awareness of UDRs among doctors and thus improve drug safety in hospitals, while concomitantly providing an important feature of further medical education.

Adverse Drug Reaction Reporting Systems↗
PubMed1997

[Sequelae of cholecystectomy].

The removal of the gallbladder is followed by a number of compensatory changes, which in most cases do not result in clinical symptoms: the loss of the pressure reservoir for the bile, the duodenogastric reflux with a subsequent increase in gastric pH and helicobacter infections as well as alterations in bile metabolism. An increased incidence of colon carcinoma has been suggested to be caused by cholecystectomy. However, this might also be due to cholelithiasis. Abdominal symptoms widely regarded as postcholecystectomy syndrome are often due to functional disorders of the gastrointestinal tract and the unrelated to the loss of the gallbladder. Therefore, the expression postcholecystectomy syndrome is imprecise and should not be used in the future. Changes affecting the bile ducts such as sphincter Oddi dyskinesia, stones and stenoses are rare and treatment by endoscopic interventions is generally successful.

Bile Reflux↗
PubMed1996

[Percutaneous endoscopic enterostomy. Advantages and risks].

AIM: The aim of the study is to analyse the benefits and risks of PEE in patients, cared for by a team with many years experience. PATIENTS AND METHODS: From 16. 2. 1988 until 31. 12. 1993 246 PEEs (229 gastrostomies, 6 duodenostomies, 7 jejunostomies, 4 attempts) were performed on 234 patients (56% male, 44% female, mean age 68.3 years). 117 patients had tumorous and 117 neurological diseases. We used the pull technique with the Fresenius Freka PEG-system. Analysis was performed using a standardised documentation sheet which was filled out until the end of tube feeding. In total, we registered 39,678 days of tube feeding, 4513 of which were in hospitalized patients. RESULTS: The mean intubation time was 192.6 days (maximum 1496). In 8 cases, the tube could be explanted before the patient was discharged; 68 patients were discharged to a nursing home and 71 patients were allowed to go home. The tube-independent hospital lethality was 36.64%. A PEE-specific lethality had not been registered. Complications arose in a total of 37 patients (15.04%), 4 of which were severe (1.63%) Fifty-nine patients (25.43%) reported short-term feelings of ill health (vomiting, diarrhoea, pain). CONCLUSION: PEE is an effective and low-risk method of long-term nutrition. The advantages are simple insertion, safe handling by patients and relatives/nursing staff and the low cost.

Adult↗
PubMed1993

[Toxic shock syndrome caused by Streptococcus pyogenes].

Four days after being bitten by an insect a 35-year-old woman without any serious underlying disease developed an extensive phlegmonous inflammation of the left eyelid which soon spread to the entire left half of her face. Streptococcus pyogenes serotype M1, which produced the erythrogenic toxin A in vitro, was isolated from two blood cultures. The course of the illness was characterized by high fever, diarrhoea, vomiting, circulatory failure, consumption coagulopathy, abnormal renal functions and a generalized exanthem with desquamation of the skin, exhibiting the full-blown picture of a toxic shock syndrome caused by S. pyogenes. She eventually recovered completely under intensive care involving administration of catecholamines, fresh frozen plasma and antithrombin III substitution, as well as antibiotic treatment with clindamycin (600 mg three times daily), ampicillin/sulbactam (4 g three times daily)--after 3 days replaced by imipenem (0.5 g four times daily)--and gentamycin (80 mg three times daily) for two weeks. Extensive necroses later required plastic surgery to the left eyelid, cheek and temporal region.

Adult↗
PubMed1991

[Oxygen saturation in endoscopic examinations of the upper gastrointestinal tract].

Oxygen saturation and pulse rate were continuously recorded using pulse oximetry in 169 consecutive upper gastrointestinal endoscopies (127 EGD and 42 ERCP). Oxygen saturation dropped to below 90% in 37 of 127 patients with EGD and 13 of 42 with ERCP. In EGD-patients with premedication (diazepam) the SaO2 was significantly lower than in patients without premedication. The lowest SaO2 is found in ERCP-patients with bile duct manipulations (EPT, stone extraction, endoprosthesis). Age, sex, patient's position, duration of the investigation and smoking had no effects. The rate of cardiovascular complications in the upper gastrointestinal endoscopy is very low. The possibility of oximetry monitoring and eventually of nasal oxygen application should be given in elderly risk patients with cardiorespiratory diseases, especially in therapeutic procedures and premedication. In younger patients without cardiac diseases an oximetry monitoring is not necessary with or without premedication. The clinical evaluation of the single patient's risk factors should determine whether or not pulse oximetry or supplementary oxygen is useful.

Aged↗
PubMed1987

[Results of percutaneous transhepatic drainage of the bile ducts].

From September 1980 to December 1986, 72 percutaneous transhepatic cholangiography drainages (PTCD) were performed in 64 patients (58 palliative in malignant obstructions, 14 temporary). The median duration of drainage was 26.8 days (2-183 days). The median survival time in 37 patients with palliative tumour drainage was 55.3 days (7-473 days). 9/37 patients survived longer than 3 months (max. 15.5 months). Complications occurred in 29.5% (10.3% severe). 3/64 patients (4.7%) died. Patients with palliative transpapillary drainages (23), especially with endoprostheses (14), survived longer, and the complication rate was lower. Therefore, we prefer the endoscopic transpapillary approach. PTCD patients must be selected carefully.

Aged↗
PubMed1986

[Brucella canis infection in man].

A Brucella canis infection, causing recurrent fever with so-called granulomatous hepatitis and splenomegaly, was detected serologically in a 30-year-old female patient. The disease originated in an infected dog from Greece which also showed a high titre. Following successful initial treatment with cotrimoxazole and streptomycin the disease broke out again on two further occasions. The infection was finally cured by 4-months continuous cotrimoxazole treatment after which the Brucella canis titre dropped from 1:1280 to 1:40 and then to zero. The patient has been symptom-free for the last two years.

Adult↗
PubMed1986

Takayasu's arteritis--a special form of the aortic arch syndrome. Manifestations of a chronical type III.

The case of a 45-year-old woman with arteritis of Takayasu's type is reported. This disease belongs to the inflammatory diseases of the aortic arch and sometimes shows extensive calcifications of the arterial system. The diagnosis is based on typical anamnesis and characteristic clinical symptoms, as well as on radiologic findings. The clinical signs depend on the extension of the disease. The literature about this rare disease is discussed.

Adolescent↗
PubMed1985

[Ischemia of the cecum caused by glycylpressin].

A case report is given of a patient with severe upper gastrointestinal bleeding, the source of which could not be localized immediately. Glycylpressin (GP) was applied since bleeding from esophageal varices was suspected. During surgery a gastric ulcer was found penetrating into the pancreas and eroding the splenic artery. A segmental ischemic necrosis of the coecum was found as well, - a complication not yet reported after use of GP. Problems of using GP as a therapeutic agent and especially intestinal necrosis as a complication are discussed. The patient had gastrectomy, splenectomy and hemicolectomy and recovered well.

Cecum↗
PubMed1983

[Results of 108 endoscopic papillotomies].

At the Medical Clinic of the St. Elisabeth Krankenhaus, Cologne, 108 endoscopic papillotomies (EPT) were carried out between September 1977 and May 1983; 90% have been successful. Choledocholithiasis in 91 patents (84,2%) was the most frequent indication. Approximately half of the cases had had previous cholecystectomy; in the other half the still existing gall-bladder contained stones. These latter patients were definite risk-patients; their average age was 16 years above that of patients with previous cholecystectomy. Other indications have been the inflammatory (14 patients) or tumorous stenosis (3 patients) of the papilla. Complications occurred with 8 patients (7,4%); mortality-rate: 1,9%. The good results and the low rate of complications make EPT the method of choice in case of residual or recurring stones after cholecystectomy as well as in case of risk patients with existing gall-bladder and stones in the common bile duct. Further indications have been: malignant or benign papillary stenosis and acute emergency situations (acute biliary pancreatitis or cholangitis through a stone blocking the duct). The nasobiliary permanent probe, the possibility of direct litholysis, the dilatation by catheter and prolonged draining of stenosis open new applications.

Aged↗