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Biomedical subjects

L Safrany

Publications and source records attributed to L Safrany.

At least 19 recordsLinked to original sources
PubMed1992

Aerobilia and hypomotility of the sphincter of Oddi in a patient with chronic intestinal pseudo-obstruction.

A 50-year-old woman with a typical history of chronic idiopathic intestinal pseudo-obstruction was admitted to hospital because of an acute episode of abdominal cramps, nausea, and vomiting. The diagnosis of chronic idiopathic intestinal pseudo-obstruction had been established in this patient who had malnutrition and extreme weight loss as a result of severe malabsorption syndrome. The abdominal roentgenogram showed a typical hypotonic intestine with an enlarged stomach and distended intestinal loops with the radiological signs of an ileus. In addition to former episodes, there was also a transient aerobilia. The patient had not undergone biliary surgery or endoscopic sphincterotomy. To investigate the cause of the findings, endoscopic retrograde cholangiopancreatography and endoscopic manometry of the sphincter of Oddi were performed. The endoscopy showed the stomach and duodenum with a wide and dilated lumen and no spontaneous motility. Endoscopic manometry of the biliary tract and the sphincter of Oddi showed several abnormalities compared with a group of normal volunteers or patients who were examined via biliary manometry for other reasons. There was a low basal pressure (3.5 mm Hg) in the sphincter of Oddi together with low-amplitude phasic contractions (25-30 mm Hg), but the contraction frequency was in the normal range. Further investigations of the motility of the gastrointestinal tract in this patient showed diffuse esophageal spasms and a markedly delayed gastric emptying. The findings of biliary manometry in this patient suggest involvement of the sphincter of Oddi and the biliary system in chronic idiopathic pseudo-obstruction.

Air↗
PubMed1988

Duodenoscopic sphincterotomy in patients with gallbladders in situ: report of a series of 1272 patients.

We present a prospective, unrandomized, uncontrolled series of 1272 patients in whom endoscopic sphincterotomy (ES) was performed, and who had not previously undergone cholecystectomy. These patients were culled from our combined experience of a total of 4177 patients in whom ES was performed over the last 13 yr. Of the group reported here, 1208 patients had demonstrable gallbladder stones, and 64 had acalculous gallbladders. The group included 896 females and 396 males whose mean age was 73.3 yr and who ranged from 17 to 101 yr old. Cholangitis was present in 317 patients (25%), and gallstone pancreatitis in 134 (10.5%) patients. After sphincterotomy, 109 patients (8.6%) developed cholecystitis; 23 developed this within 48 h, and 86 developed this within 10 days of the procedure. Emergency surgery was performed on 25 of these patients, and 84 responded to medical therapy alone. Two deaths occurred within 30 days of sphincterotomy (0.15%), in both cases following emergency surgery in elderly patients. One hundred-eight patients underwent elective cholecystectomy within 3 yr of their sphincterotomy because of recurrent symptoms referrable to the biliary tract. In a subset of 337 patients in whom long-term followup was possible, two patients died of complications related to recurrent cholecystitis, both at approximately 2 yr after sphincterotomy. Although followup was less than optimal in this large series of patients, the data presented here suggest that an intact gallbladder is not a contraindication to ES in the management of common bile duct stones, and that the morbidity and mortality of ES compare favorably over the long and short term with surgical management.

Adolescent↗
PubMed1978

Endoscopic treatment of biliary-tract diseases. An international study.

Data on endoscopic sphincterotomy from 15 gastroenterology centres with very wide experience show that 3618 out of 3853 (93.%) attempts at the procedure were successful. The main indication for sphincterotomy was choledocholithiasis (3070, or 84.9% cases). After sphincterotomy the stones passed spontaneously or were removed in 2779 (90.5%) cases. Bleeding, cholangitis, pancreatitis, perforation, and stone impaction occurred in 254 (7.0%) cases; the mortality-rate was 1.4%. 83 (2.3%) cases required emergency surgery. Endoscopic sphincterotomy is increasingly replacing surgery in the treatment of choledocholithiasis.

Ampulla of Vater↗
PubMed1978

Radiation exposure in patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic papillotomy.

Radiation exposure was studied in 327 patients undergoing endoscopic retrograde cholangiopancreatography, or endoscopic papillotomy taking into account fluoroscopy time and incident area exposure. The mean fluoroscopy time was 238 +/- 152 seconds and the incident area exposure 3,730 +/- 2,790 R X cm2. These results were compared with standard exposures in upper GI series and colon examinations as found in the literature.

Adult↗
PubMed1978

Endoscopic retrograde cholangiography (ERC) in surgical emergencies.

Twelve patients, presenting with an acute abdomen of suspected biliary tract origin, had endoscopic retrograde cholangiography performed. Eight patients had either traumatic, spontaneous, or postoperative biliary tract fistulas with five leading to the peritoneal cavity, one to the colon, one to the bronchial tree, and one to the liver parenchyma from a ruptured gall-bladder. Each was confirmed by endoscopic retrograde cholangiography. Four patients with jaundice, following traumatic rupture of the liver, had a pathological communication between the intrahepatic biliary tracts and the hepatic vascular system. It is concluded that ERC is a reliable method for obtaining precise localization of biliary tract problems in surgical emergencies both pre- and post-operatively.

Adolescent↗
PubMed1978

[Hemobilia and bilhemia complicating liver trauma (author's transl)].

Hemobilia and bilhemia are typical complications of liver trauma which have been found more often during the last years. Today gastroduodenoscopy, retrograde cholangiography, selective angiography and scintillation scanning of the liver make an exact diagnosis possible. In the case of hemobilia a ligature of the corresponding artery might be successful, whereas in the case of bilhemia only partial resection of the liver leads to success.

Adolescent↗
PubMed1978

[Juxtapapillary diverticula of the duodenum and bilio-pancreatic symptoms (author's transl)].

Juxtapapillary diverticula of the duodenum are more frequent than has been assumed up to now. Among 2100 patients undergoing duodenoscopy 135 duodenal diverticula have been found. These diverticula may cause symptoms of diverculitis as well as of bilio-pancreatic disease. Such diverticula ought to be treated by surgery. In our department diverticula are turned inward, or a papillo-diverticulotomy is done depending upon the localization of the diverticula.

Cholangitis↗
PubMed1977

[Therapeutic endoscopic retrograde cholangiography (author's transl)].

Endoscopic papillotomy is a further development of endoscopic cholangiography. This therapeutic procedure was successful in 516 (94.7%) of 545 cases. Choledocholithiasis (405 cases) and papillary stenosis (97) were the main indications for the procedure. Of 405 patients with choledocholithiasis, 376 (93%) are now free of stones. There were 38 (7.4%) complications and 5 (1%) of these had a lethal outcome with (11) (2%) requiring emergency laparotomy. Cholangitis was the most serious complication. It is becoming increasingly evident that the endoscopic papillotomy is replacing reoperation in many cases of choledocholithiasis.

Cholangiography↗
PubMed1977

[Diverticula of the stomach - diagnosis of their importance (author's transl)].

Gastric diverticula may be due to dilatation or traction. 75% are found in the fundus, 15% in the prepyloric antrum. In 10% they were situated elsewhere. Symptoms are unspecific. Radiography has to be combined with endoscopic investigation of their nature. Smaller diverticula are mainly treated conservatively, the larger ones will require surgery because of chronic symptoms and complications.

Diagnosis, Differential↗
PubMed1977

Duodenoscopic sphincterotomy and gallstone removal.

Duodenoscopic sphincterotomy was attempted in 265 patients. The procedure was successful in 243 patients (92%). Indications for sphincterotomy were: 185 patients with choledocholithiasis, 52 patients with papillary stenosis, and 6 patients with ampullary carcinoma. The clinical and biochemical evidence of cholestasis resolved in 222 of the 243 successful patients (91%). Complications consisting of hemorrhage, perforation, pancreatitis, cholangitis, and instrumental injury resulted in three deaths, an over-all mortality of 1.2%. Emergency laparotomy was required in 6 cases (2.5%). Duodenoscopic sphincterotomy is a relatively safe and effective means of relieving certain instances of extrahepatic cholestasis. The complication and mortality rates appear lower than those with equivalent conventional surgical techniques.

Adult↗
PubMed1977

[Bronchobiliary fistula. Pathogenesis, diagnosis, therapy].

The case demonstrated shows the pathomechanism of bronchobiliary fistula. In most cases, bronchobiliary fistulae are caused by stenosing lesions of the common bile duct. For diagnosis the combined cholangio-bronchography is the preferred method. Removal of the obstructing lesion is the aim of operative treatment. Usually spontaneous healing of the bronchobiliary fistula results.

Adult↗
PubMed1975

Endoscopic papillotomy and removal of gall stones.

Endoscopic papillotomy was attempted in 59 patients with extrahepatic obstruction of the biliary duct system and was actually performed in 50 patients. A special high-frequency diathermy knife was introduced via a duodenoscope into the terminal common bile duct and the roof of the papilla was incised. In 33 out of 39 patients with choledocholithiasis the stones passed into the duodenum spontaneously or were removed endoscopically. Papillary stenosis without ductal stones was successfully treated with this method in eight out of 11 patients. One perforation of the duodenocholedochal junction occurred and was repaired surgically. Endoscopic papillotomy and stone extraction is a relatively safe and effective method of treating extrahepatic jaundice.

Aged↗
PubMed1975

[Hemobilia (author's transl)].

Hemobilia is a syndrome caused by hemorrhage into the biliary ducts. It is characterized by colicky pains, jaundice, and intestinal bleeding; a correct diagnosis of this syndrome is made rather rarely. The most common cause is trauma; inflammatory or tumorous disease of the liver and bile duct system, bile stones and aneurysms of the hepatic artery are rarer causes. The diagnosis can be established and the arterio-biliary fistula localized by selective arteriography. A case is described, which shows, that, in addition, duodenoscopy with retrograde cholangiography is of diagnostic value. Other helpful diagnostic procedures are: splenoportography, liver scanning, and intraoperative cholangiography. Therapy must be surgical exclusively; palliative operations lead to high rates of relapses and letality. Best results are achieved by ligature of the hepatic artery in cases of central, or by partial resection of the liver in cases of peripheral localization of the fistula.

Accidents, Traffic↗