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Biomedical subjects

M Staritz

Publications and source records attributed to M Staritz.

At least 19 recordsLinked to original sources
PubMed1992

[Decompression sickness as differential diagnosis in internal medicine emergency admissions].

Two men (aged 37 years--patient 1, and 26 years--patient 2), both in good health, had dived as a sport to a depth of 40 and 45 m, respectively, reportedly keeping to the prescribed decompression times on their ascent. Patient 1 immediately developed shortness of breath and pain in the chest, later neurological deficits in both legs, as well as faecal and urinary incontinence. Examination 60 h later revealed paraparesis, increased leg proprioceptor reflexes and paraesthesia below the 10th thoracic vertebra, with abnormal posterior column function. After recompression (hyperbaric oxygenation, 6 treatment sessions of 4 h each over 8 days, as prescribed in US Navy Table No. 6) the signs improved and two months later there were no deficits. Patient 2 developed 30 min after a similar dive painful, doughy swellings and redness over the upper ventral half of the thorax and both upper arms. All signs and symptoms disappeared after recompression treatment (hyperbaric oxygenation for 3 h), begun 28 h after the dive. Previously elevated levels for haemoglobin (18.5 g/dl), haematocrit (0.56) and red blood corpuscles (5.98 x 10(6)/microliters) returned to normal. The described neurological abnormalities are typical for type II, redness and joint pains for type I decompression sickness.

Adult↗
PubMed1992

Percutaneous obliteration of the cystic duct with a holmium:yttrium-aluminum-garnet laser: results of in vitro and animal experiments.

OBJECTIVE: The purpose of this study was to investigate the feasibility of using a holmium:yttrium-aluminum-garnet laser to permanently occlude the cystic duct in order to isolate the gallbladder from the biliary-enteric circulation and prevent gallstone formation. MATERIALS AND METHODS: To determine the optimal laser parameters (power and pulsing rate) for cystic duct thermocoagulation, 20 freshly excised porcine gallbladders with intact cystic ducts underwent low-energy (0.075-0.085 J/pulse) or high-energy (0.20-0.25 J/pulse) thermocoagulation. Histopathologic examination was done to determine the extent of cystic duct injury. After in vitro experiments, percutaneous transcholecystic laser thermocoagulation of the cystic duct was performed on 23 anesthetized domestic pigs (four controls). Cholangiograms immediately after laser thermocoagulation were obtained to assess cystic duct occlusion. Animals were sacrificed for histopathologic correlation immediately after laser thermocoagulation (n = 4), 72 hr later (n = 4), and 6 weeks later (n = 15). RESULTS: In the in vitro studies, all 10 cystic ducts in the high-energy group were occluded, while only four in the low-energy group were occluded. At histology, all cases in both groups showed circumferential injury to the cystic duct wall without injury to the cystic artery or vein. In the in vitro experiments, the cystic duct was successfully cannulated in 21 (91%) of 23 animals. Cholangiography after thermocoagulation showed occlusion of the cystic duct in 16 (84%) of 19 cases. Immediately after laser thermocoagulation, the cystic duct mucosa was circumferentially destroyed, whereas after 72 hr necrosis of the cystic duct wall and periductal tissues had occurred. By 6 weeks, all pigs had complete cystic duct fibrosis without injury to the common bile duct. CONCLUSION: Holmium:yttrium-aluminum-garnet laser thermocoagulation of the cystic duct can be performed easily, results in immediate cystic duct occlusion, and leads to permanent fibrous ductal obliteration by 6 weeks.

Animals↗
PubMed1992

[The time requirement for endoscopic diagnosis and therapy: results of a multicenter study].

For evaluation of the time requirements for endoscopic diagnostic and therapeutic procedures data of 13,321 patients gathered from 155 endoscopic units were collected. Time requirements were calculated for preparation of the procedure, examination and after-care of patients and instruments. The data indicate, that time requirement is significantly influenced by the special procedure. Therefore, calculation of the time requirement of an individual unit needs exact consideration of the frequency of different procedures. Only cleaning of instruments by washing machines could be shown to reduce time requirement. Education of endoscopists was demonstrated to be time intensive. Age (exemption children) sex of patients and video-endoscopy did not effect duration of procedures.

Adolescent↗
PubMed1992

[Computerized tomography analysis of gallstones: soon an essential diagnosis before nonsurgical gallstone therapy?].

Successful application of non operative procedures for gallstone therapy are limited on cholesterol stones. Therefore reliable therapeutic analysis of stone components is mandatory for planning of an adequate therapy. Computed tomographic gallstone analysis is considered to improve selection of patients significantly. However, standardized conditions for investigation of patients are not yet established. It is suggested that computerized tomography should be performed using 4 mm slides, standardized position of patients and a phantom, which allows calibration of different CT-machines.

Bile Pigments↗
PubMed1992

[Therapy of choledocholithiasis using extracorporeal shock wave lithotripsy and adjuvant surgical endoscopy].

Extracorporeal shock wave lithotripsy of extra- and intrahepatic bile duct stones is indicated after failure of conventional operative endoscopic procedures including mechanical lithotripsy. An overview of the current literature (12 centers, 568 patients) indicates that this novel procedure has attracted international acceptance. It was applied in elderly patients (means = 65 years) with solitary (37.5%) or multiple (62.5%) concrements. Clearance of the bile ducts was achieved in 71.6% after 1.3 to 3.0 lithotripsy sessions (1900-4000 shocks) if additional endoscopic sphincterotomy was performed. Without sphincterotomy 61% of patients were treated successfully. The most frequent side effects were macrohematuria (6.9%), hemobilia (6.2%) cholangitis (4.5%) and pancreatitis (1.3%). A lethality of 0-3.6% (means = 0.6%) was reported. The current results demonstrate that therapy of extra- and intrahepatic bile duct stones with extracorporeal shock wave lithotripsy is effective, safe and provides high therapeutic comfort.

Aged↗
PubMed1991

[Extrasystoles during extracorporeal biliary shockwave lithotripsy. Their incidence and clinical significance].

Incidence and clinical significance of cardiac side effects of extracorporeal shock-wave lithotripsy (ESWL) were prospectively analysed for 85 patients (26 men, 59 women; mean age 44 [17-81] years) with cholecystolithiasis (n = 70) or choledocholithiasis (n = 15). 24-hour ECG monitoring was undertaken on the day of treatment. Additionally, during ESWL cardiac rhythm and blood pressure were monitored. ESWL was performed with an electromagnetic lithotriptor under light anaesthesia with intravenous diazepam (10 mg) and pethidine (75-100 mg). There were no superventricular premature systoles in any of the patients during treatment. In 15 patients with occasional ventricular premature systoles (VPS) (6-81 per 23 hours) in the 24-hour ECG the number of VPS increased during the one-hour ESWL procedure significantly to 6-55 (P less than 0.05). 14 of these patients had an unremarkable cardiac history. Changing the lithotriptor coupling angle failed to suppress the VPS in only two patients. In these two it was necessary to trigger the shock wave with the ECG. Blood pressure rose markedly (up to 220 mm Hg systolic) during ESWL in only three patients, known hypertensives. But this rise was easily controlled with nifedipine, 10 mg sublingually. These data demonstrate that ESWL is a safe alternative to operative treatment, even in the presence of existing cardiac disease. Nonetheless, precautions should be taken in case there are complications.

Adolescent↗
PubMed1991

Investigation of the effect of duodenoscopy on sphincter of Oddi manometry.

To investigate whether endoscopy affects sphincter of Oddi (SO) manometry, three patients who had undergone previous cholecystectomy and had a T-tube in situ for drainage were studied. Manometry was performed using a perfused triple lumen manometry catheter (diameter 1.7 mm), which was advanced into the SO lumen through the T-tube. SO motility, baseline pressure, common bile duct pressure and duodenal pressure were monitored before and during endoscopy while the tip of the endoscope was in the mouth, esophagus (upper third, precardial), stomach and duodenum. Endoscopy and even a moderate insufflation of air necessary to pass the pylorus and inspect the papilla of Vater did not affect the parameters mentioned. Thus, ERCP manometry is a reliable method for evaluation of SO motility which is not affected by endoscopy. Duodenal pressure is a stable parameter and suitable for serving as reference pressure.

Adult↗
PubMed1991

Electromagnetically generated extracorporeal shock wave lithotripsy and adjuvant combined oral litholysis for therapy of symptomatic gallbladder stones.

A prospective study was conducted to evaluate effectivity, problems and adverse effects of extracorporeal shock wave lithotripsy (ESWL) using a newly developed electromagnetic biliary lithotriptor (Lithostar Plus, Siemens, Erlangen, FRG) for the treatment of selected patients presenting with symptomatic cholecystolithiasis. In addition to generally accepted criteria for the selection of patients, gallbladder contractility was established and pigment stones were excluded by computed tomography (CT). 80 out of 486 patients (63 females, 17 males, mean age 36, range 17-76 years) were selected for ESWL using a standardized diagnostic program. 62 out of 80 patients participating in the study had solitary concrements (diameter 23.3 +/- 6.4 mm) while in 18 patients 2 or 3 stones (diameter below 10 mm) were observed. Stone fragmentation was achieved after an average of 1.35 treatment sessions (range 1-3) in 78 (97.5%) patients. No clinically relevant adverse effects were observed. Immediately after ESWL, ultrasound revealed misleading results with regard to stone fragmentation. 98.7% of patients (n = 77) were seen for follow-up investigations 3, 6 and 9 months after ESWL, and 82% at 12 months. A total of 40 (53%) patients became free of stones. Subgroup analysis showed that 68% of the patients were free of stones (stone diameter 10-20 mm), 54% (20-30 mm) and 33% (multiple stones), respectively. We therefore conclude that ESWL should be restricted to highly selected patients presenting with small (10-20 mm) solitary concrements.

Administration, Oral↗
PubMed1991

[Computerized tomography differentiation of pigment and cholesterol bile duct calculi].

Successful oral litholytic and other non-operative therapies of gallstones require exact determination of the stone components. Since computed tomography (CT) provides highly sensitive measurement of density, we performed a study to evaluate whether CT measurement of stone density allows to predict the composition of radiolucent gallstones. 28 patients presenting with 29 radiolucent gallbladder (n = 17) or common bile duct stones (n = 12) were included. Prior to operative or endoscopic therapy the attenuation values (Hounsfield Units/HU) were assessed in vivo by CT under standardised conditions (Somatom II; 125 KV; 130 mAs). After surgical or endoscopic stone removal the concrements were dehydrated, homogenised and then analysed by infrared spectroscopy. 18 cholesterol and 11 pigment stones could be identified. The attenuation values (Hounsfield Units) of cholesterol stones amounting to 28-98 HU (48.7 +/- 4.4 HU) differed significantly (p less than 0.001) from pigment stones (90-120 HU/105.5 +/- 2.8 HU). We conclude that computed tomography provides exact discrimination between cholesterol and pigment stones in vivo. Since only cholesterol stones can be dissolved by cheno/ursodeoxycholic acid we recommend to measure the radiodensity of gallstones by CT prior to any litholytic therapy.

Bile Pigments↗
PubMed1990

[Esophageal varices: is bleeding predictable?].

Hemorrhage of oesophageal varices is still a life-threatening complication of portal hypertension. Parameters to identify patients being on risk to bleed are on demand for prophylactic therapy. Recent studies showed that bleeders present with larger varices, red color sign of the variceal wall and higher intravariceal hydrostatic pressure than patients without previous hemorrhage. Advanced liver disease (Child C) is an additional risk factor. The clinical value of the parameters appears to be decreased by a significant overlap of the findings obtained in bleeders and non-bleeders. However, patients with small varices, low variceal pressure (less than 12 mmHg) and fair condition are considered to be not on risk to bleed from varices. An additional clinical value of the parameters is provided by the potency to define patients more accurately for future clinical studies.

Esophageal and Gastric Varices↗
PubMed1990

[Gallstone treatment using extracorporeal shockwave lithotripsy and adjuvant oral lysis: status and perspective].

Three years of clinical experience and the results of the "First International Symposium of Biliary Lithotripsy" showed that extracorporeal shock waves disintegrate cholesterol, pigment and calcified stones into fragments of 1 to 8 mm in diameter. Since spontaneous passage of fragments through the bile ducts is not possible, the therapeutic goal must be achieved with adjuvant oral lysis of the fragments. Therefore, only cholesterol stones are suitable, and a contractile gallbladder as well as a limited stone volume are prerequisites. After one year of treatment, in 45 to 80% of patients complete clearance of stone fragments from the gallbladder is observed. During this period one third of the patients experiences occasional colics. Further severe complications have not been reported.

Bile Acids and Salts↗