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Biomedical subjects

J Sontheimer

Publications and source records attributed to J Sontheimer.

15 recordsLinked to original sources
PubMed2004

Dieulafoy lesion in a one-year-old child.

The Dieulafoy lesion is a rare cause of severe upper gastrointestinal bleeding associated with a significant mortality. Rebleeding from undiscovered lesions is frequent and often fatal. The outcome depends on a high degree of suspicion for the condition. In any age group, the entity may be underdiagnosed rather than truly rare. It is particularly uncommon in infants. The authors report the case of the youngest patient so far to suffer from a Dieulafoy lesion.

Endoscopy, Digestive System↗
PubMed1999

Evaluation of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose for the differentiation of chronic pancreatitis and pancreatic cancer.

BACKGROUND: The clinical presentation of patients with pancreatic cancer may resemble the clinical picture of chronic pancreatitis. A definitive preoperative diagnosis is not always obtained in patients with a history of chronic pancreatitis despite the use of modern imaging techniques. Operative strategy therefore remains unclear before operation in these patients. METHODS: Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (FDG) was introduced recently into clinical oncology because of its ability to demonstrate metabolic changes associated with various disease processes. The impact of FDG-PET on the differentiation of chronic pancreatitis and pancreatic cancer was investigated. FDG-PET was performed in 48 patients with chronic pancreatitis (n = 12), acute pancreatitis (n = 3) and pancreatic cancer (n = 27), and in controls (n = 6). Histological examination was undertaken in all cases except controls. The FDG-PET results were obtained without knowledge of results of other imaging procedures. The results were then compared with those of computed tomography, ultrasonography, endoscopic retrograde cholangiopancreaticography, operative findings and histology. PET images were analysed semiquantitatively by calculating a standard uptake value (SUV) 90-120 min after application of the tracer. RESULTS: Cut-off values were validated as follows: SUV greater than 4.0 for pancreatic cancer, SUV of 3.0-4.0 for chronic pancreatitis, and SUV of less than 3.0 for controls. Sensitivity and specificity of PET imaging were 0.96 and 1.0 for pancreatic cancer, and 1.0 and 0.97 for chronic pancreatitis. In five cases only FDG-PET led to the correct preoperative diagnosis. CONCLUSION: The results give further evidence that FDG-PET is an important non-invasive method for the differentiation of chronic pancreatitis and pancreatic cancer. Delayed image acquisition in the glycolysis plateau phase permits improved diagnostic performance. This imaging technique is extremely helpful before operation in patients with an otherwise unclear pancreatic mass, despite its costs.

Adult↗
PubMed1991

Bacteremia following operative endoscopy of the upper gastrointestinal tract.

The rate of bactaeremia following surgical endoscopy of the upper gastrointestinal tract is reported with up to 50% depending on the therapeutic measure performed. In a prospective study we examined 160 patients treated by surgical endoscopy of the upper digestive tract. The rate of bactaeremia showed a significant difference with 12.5% after diagnostic and 28.96% after surgical endoscopy. Our results recommend a single shot antibiotic prophylaxis depending on the endoscopic measure performed and the patient's individual risk.

Anti-Bacterial Agents↗
PubMed1991

[Percutaneous transhepatic endoscopy and targetted tissue removal with an F-10.2 maneuverable thin cholangioscope].

Due to the flexibility and an external control mechanism of our thin calibrated cholangioscope (10.2 F) an inspection of the bile ducts via percutaneous transhepatic access is possible without too much discomfort for the patient. A 3.6 F working channel enables target-specific biopsies under optical control. It does not only enable histological diagnosis of the tumour itself but above all the exact definition of the proximal and distal tumour borders. This is a decisive criterion of operability and operation planning especially in tumours of the hepatic bifurcation. Expansion of the compressive lesion may be determined for palliative treatment. Percutaneous stone extraction by contact lithotripsy or with a Dormia basket is technically possible via the working channel under endoscopic view. An inspection of the peripheral branches of the same and the other liver lobe from one access only is made possible by easy maneuverability and flexibility of the endoscope.

Adenocarcinoma↗
PubMed1991

[Percutaneous transhepatic cholangioscopy for gallstone therapy and tumor diagnosis].

Using percutaneous-transhepatic cholangioscopy with a guided small calibre, cholangioscope (3.5 mm) in patients with obstructive jaundice it is possible to perform biopsies under visual control or to look for the exact intraductal extension of a tumor with only little stain on the patient. The access may be via a puncture of the right or the left hepatic duct. Since 1987 we have used this method 61 times in 45 patients. Some 32 patients suffered from malignancy of the bile duct. Of 13 patients with benign obstruction we performed a bougienage in 8. The other 5 patients were treated by stone extraction.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

Nonendoscopic percutaneous gastrostomy.

Tight peritoneal adherence of the stomach to the abdominal wall as a prerequisite of percutaneous gastrostomy can be achieved by a newly developed cannula. It serves for puncture and fixation of the gastric wall. Thus, percutaneous gastrostomy can be established safely even in instances of an endoscopically nonaccessible stomach. Further applications of the device for the purpose of intestinopexy and facilitation of endoscopic procedures are being evaluated.

Esophageal Neoplasms↗
PubMed1989

[Surgical treatment of cholelithiasis].

The indication for cholecystectomy has undergone a distinct change over the last few years due to the development of endoscopic and medical forms of therapy. The incidence of silent gallstones discovered incidentally has greatly increased owing to the widespread use of ultrasound. While surgery is not indicated in these cases, it is mandatory in acute and chronic septic complications, obstruction of the cystic duct or non-functional gallbladder. In a small number of patients, cholecystolithiasis can be treated with ESWL and chemolitholysis, but most will need surgery. Cholecystectomy is the sole causal therapy. Except in young patients, common bile duct stones are the domain of endoscopic papillotomy, even when the gallbladder is left in situ temporarily or (in high-risk patients) permanently. Here, endoscopy supplements the therapeutic concept even in emergency cases; stone extraction can obviate the need for common bile duct revision. Morbidity and mortality of gallstone surgery increase appreciably with patient age. Early operation is recommended in acute cholecystitis because of the lower morbidity and mortality rates. Present possibilities of individualized therapy require good interdisciplinary cooperation to prevent serious complications.

Ampulla of Vater↗
PubMed1989

Technical aid for facilitating emergency endoscopy.

Emergency endoscopy is usually complicated by unfavorable examination conditions. The irrigating capability of the instrument is inadequate. The use of an easy-to-operate volume- and pressure-driven irrigation pump has proved very efficient and safe in the hands of an experienced endoscopist, and helps establish the correct diagnosis or provide proper treatment.

Emergencies↗
PubMed1989

[Choledocho-gastric fistula. A rare complication of a cholangiocarcinoma].

A case of choledocho-gastric fistula resulting from a cholangio-carcinoma is reported. The final diagnosis was obtained by ERCP, whereas CT, barium examination, and gastroscopy initially did not allow a conclusive diagnosis. The only clinical finding was epigastric pain. Choledocho-gastric fistula is extremely rare.

Adenoma, Bile Duct↗
PubMed1988

[A new Y-endoprosthesis for drainage of bile duct obstruction of the hepatic bifurcation].

Biliary decompression in cases of central tumorous biliary obstruction requires surgical or internal/external catheter bypass techniques. The development of a 14-F Y-shaped-polyurethane endoprosthesis stent provides the possibility to drain the left and right biliary system simultaneously. The endoprosthesis is placed by a combination of external transhepatic and endoscopic approach. The tip of the singular choledochal stent segment is placed within the choledochus or duodenum.

Cholestasis, Intrahepatic↗
PubMedDate not supplied

Different counterregulatory responses to human insulin (recombinant DNA) and purified pork insulin.

The biologic effect of human insulin (recombinant DNA) and purified pork insulin (PPI) was compared during insulin-induced hypoglycemia at two intravenous dosages 0.075 and 0.1 U/kg body wt in healthy volunteers. Serum insulin concentrations and plasma glucose curves were identical. PPI induced a significantly (P less than 0.05) higher output of epinephrine, growth hormone, and cortisol at both doses. Less inhibition (P less than 0.05) of endogenous insulin secretion was observed for human insulin at 0.1 kg body wt. An elevated incidence of sweating during hypoglycemia was related to epinephrine secretion. The results indicate that homologous insulin produces in vivo effects which are different from those produced by heterologous insulin.

Adult↗