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Biomedical subjects

M Sackmann

Publications and source records attributed to M Sackmann.

85 records · Page 5Linked to original sources
PubMed1988

A retrospective analysis of 3 year's experience of an interdisciplinary approach to gallstone disease including shock-waves.

1206 patients with gallstone disease were treated between January 1985 and December 1987, using an interdisciplinary concept that included surgery, endoscopic sphincterotomy, and extracorporeal shock-wave lithotripsy (ESWL). Twenty-five per cent of the patients who were admitted for gallbladder stones were treated by ESWL, whereas 75% underwent surgery. Mortality of elective treatment for gallbladder stones amounted to 0.25% (0.4% in surgery, 0% in ESWL). Postoperative complication rate was low (4.2% in surgery, 7.0% in ESWL). After ESWL treatment, 80% of the patients were free of stones after a follow-up period of 1 year. Recurrence rate in these patients amounted up to 10%; in seven of 70 patients, mean follow-up period was 6 months after complete disappearance of stones. Twenty-seven per cent of all patients who were admitted for bile duct stones underwent surgery, whereas in the other 73%, calculi were removed via endoscopy. ESWL treatment was used additionally, if necessary. Fragments were left behind in three of 75 patients (4.0%) after surgical treatment, and in 7 of 200 patients (3.5%) after endoscopic and ESWL treatment, respectively. In the latter group, three patients (1.5%) required an additional operation. There were no deaths in either of the groups. The use of ESWL for treatment of gallbladder stones needs to be evaluated in long-term follow-up studies. Thus far, surgery remains the dominating method. Endoscopic procedures, eventually combined with ESWL, represent the preferred treatment for patients with bile duct stones.

Aged↗
PubMed1987

Simultaneous determination of pool sizes and fractional turnover rates, of deoxycholic acid, cholic acid and chenodeoxycholic acid in man by isotope dilution with 2H and 13C labels and serum sampling.

This paper describes a method for simultaneous determination of the kinetics of the three major bile acids in man using (2,2,4,4-2H4) deoxycholic acid, (24-13C) cholic acid and (24-13C) chenodeoxycholic acid. The gas chromatographic/mass spectrometric-selected ion monitoring technique used provided complete separation of deoxycholic acid, cholic acid and chenodeoxycholic acid, which permitted simultaneous measurement of isotope ratios for all three bile acids. Since measurement of all three pool sizes and fractional turnover rates in a single experiment requires different isotopic labels for deoxycholic acid and cholic acid, we investigated the in vivo stability and applicability of (2,2,4,4-2H4) deoxycholic acid as a stable isotope marker for isotope dilution studies in man. No consistent differences were observed between deoxycholic acid pool sizes and fractional turnover rates determined in serum samples after administration of (2,2,4,4-2H4) deoxycholic acid and (24-13C) deoxycholic acid. Simultaneous administration of (2,2,4,4-2H4) deoxycholic acid, (24-13C) cholic acid and (24-13C) chenodeoxycholic acid and isotope ratio measurements in serum permitted determination of pool sizes and fractional turnover rates of the three major bile acid and the 7 alpha-dehydroxylation fraction. Pool sizes, fractional turnover rates and synthesis rates (input rates) agreed well with data obtained previously with (24-13C) labels in independent studies.

Carbon Isotopes↗
PubMed1987

Disintegration of a pancreatic duct stone with extracorporeal shock waves in a patient with chronic pancreatitis.

We report the case of a 33-year-old woman with chronic calcifying pancreatitis in whom an intraductal pancreatic stone with a diameter of 8 mm was successfully disintegrated with extracorporeal shock waves, permitting subsequent endoscopic extraction of the fragments. The patient had a mild attack of pancreatitis after the treatment. We conclude that shockwave lithotripsy of a pancreatic duct stone in patients with chronic pancreatitis is possible. It should, however, be viewed with reservation until further experience has been gained.

Adult↗
PubMed1984

Simultaneous determination of cholic acid and chenodeoxycholic acid pool sizes and fractional turnover rates in human serum using 13C-labeled bile acids.

A method has been developed for simultaneous determination of pool sizes and fractional turnover rates (FTR) of chenodeoxycholic acid (CDCA) and cholic acid (CA) in man by 13C/12C isotope ratio measurements of bile acids in serum after oral administration of 20-50 mg of [24-13C]-labeled bile acids. 13C/12C isotope ratio measurements were performed by capillary gas-liquid chromatography/electron impact mass spectrometry. CA and CDCA kinetics in serum measured by this method exhibited first order kinetics and permitted calculation of pool size and FTR of CA and CDCA. The validity of the measurements in serum was tested by simultaneous measurements in bile in three healthy volunteers and in five patients with various hepatobiliary disorders (three patients with cirrhosis, one with cholecystectomy and sphincterotomy, and one with sphincterotomy only). No consistent differences were found between the pool sizes and FTR's obtained from serum and bile. In a total of five healthy volunteers bile acid kinetics were measured in serum. The values found for the pool sizes and FTR's of CA and CDCA in these subjects were in excellent agreement with data reported in the literature based on 14C or 3H measurements in bile. The pool sizes (mean +/- SD) of CDCA and CA were 32.6 +/- 9.9 and 31.8 +/- 16.0 mumol X kg-1, respectively. The corresponding values for the FTR's were 0.24 +/- 0.13 and 0.48 +/- 0.22 d-1. These data demonstrate that pool sizes and fractional turnover rates of cholic and chenodeoxycholic acid can be measured simultaneously by blood sampling after oral administration of the respective 13C-labeled bile acids.

Adult↗
PubMedDate not supplied

Evaluation of gallbladder volume and emptying with a novel three-dimensional ultrasound system: comparison with the sum-of-cylinders and the ellipsoid methods.

To overcome the geometrical limitations of current methods to calculate gallbladder volume from two-dimensional sonographic images, we evaluated the accuracy and precision of a novel three-dimensional ultrasound system (3D). In vitro accuracy of 3D volumetry (10 mL to 55 mL) was 98.1 +/- 7.1% (mean+/-SD) with a mean difference of 0.7 mL between the measured and the true volume (p < 0.003). Compared with the sum-of-cylinders (SC) and the ellipsoid (EL) methods, 3D was characterized by a significantly smaller systematic bias and closer limits of agreement with the true volume. The variation coefficient was smallest with 3D (2.4%, p < 0.02) and largest with EL (4.2%). In vivo, gallbladder volumes were on average 1.4 mL (9%) smaller with 3D than with SC (p < 0.0001) and 2.4 mL (14%) larger with EL than with SC (p < 0.0001). 3D ultrasonography accurately measures gallbladder volume and emptying.

Cholelithiasis↗
PubMedDate not supplied

Biliary lithotripsy by extracorporeally generated shock waves.

Shock wave lithotripsy is a noninvasive treatment for gallstone disease, suitable for about 20% of the patients, and does not require anesthesia. Clearance of the fragments depends on: stone number and size, sufficient fragmentation and bile acid dissolution therapy. Several months are required for complete fragment disappearance. The recurrence rate is relatively low.

Chemotherapy, Adjuvant↗
PubMedDate not supplied

Surgical intervention following fragmentation of gallstones by extracorporeal shock waves.

Five cases of surgical intervention following extracorporeal shock wave lithotripsy (ESWL) of gallbladder and bile duct stones are reported. This represents an incidence of surgical intervention in 1% of patients with gallbladder stones and in 9% of patients with common bile duct stones who underwent ESWL during a two-and-a-half-year investigation period. There was no mortality. In 2 patients with gallbladder stones and persistent colic after ESWL, elective cholecystectomy was performed. There was no evidence of macroscopic or microscopic damage or bleeding within the wall of the gallbladder. Furthermore, no damage to the liver, common bile duct, duodenum, or stomach was noted. ESWL was applied in 34 patients with common bile duct stones in whom endoscopic sphincterotomy and stone extraction had proved ineffective. Three (9%) of these patients required surgery. In 1 patient, a Dormia basket got stuck and the basket, together with the stone, were removed by choledochotomy. In a second patient, rupture of a juxtapapillary diverticulum occurred 10 days after ESWL and 2 days after endoscopic extraction of stone fragments. At laparotomy, the retroperitoneum was drained. In a third patient with gallbladder and common bile duct stones, acute cholecystitis developed after lithotripsy of common bile duct stones. Cholecystectomy was performed and a t-tube was inserted in the bile duct. In all patients, the postoperative course was uneventful. In our experience, ESWL is a safe procedure with no mortality and an infrequent need for surgical intervention.

Adolescent↗