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M Staritz

Publications and source records attributed to M Staritz.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1990

Analysis of radiolucent gallstones by computed tomography for in vivo estimation of stone components.

Successful oral litholytic and other nonoperative 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 a prediction of the composition of radiolucent gallstones. Twenty-eight 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 standardized conditions (Somatom II, 125 KV, 130 mAs). After surgical or endoscopic stone removal the concrements were dehydrated, homogenized and then analysed by infra-red spectroscopy. The previously measured Hounsfield units were not known to the investigator. Eighteen 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 non-cholesterol stones in vivo. Since only cholesterol stones can be dissolved by cheno- and ursodeoxycholic acid we recommend measurement of the radiodensity of gallstones by CT prior to any litholytic therapy. Furthermore the prediction of the stone composition facilitates the decision on extracorporeal shock wave lithotripsy and the selection of specific solvents for contact lysis via a nasobiliary probe.

Bilirubin↗
PubMed1990

Electromagnetically generated extracorporeal shockwaves for fragmentation of extra-and intrahepatic bile duct stones: indications, success and problems during a 15 months clinical experience.

Electromagnetically generated extracorporeal shock waves (without waterbath) were applied after intravenous premedication with 10-15 mg diazepam and 100 mg tramadol in the treatment of 33 patients (aged 32 to 91 years) with multiple intrahepatic stones (n = 4) or huge common bile duct stones (n = 29, 18-30 mm in diameter), which could not be removed by conventional endoscopy. Stone disintegration was achieved in 70% of common bile duct stones and in all intrahepatic concrements after 800-7500 discharges, which were applied during one (n = 21), two (n = 6) or three sessions (n = 6). Apart from mild fleabite-like petechiae at the side of shock wave transmission no other side effects were observed for a total of 51 procedures. We believe electromagnetically generated shock waves are safe, easy to apply, and relatively effective in the therapy of common bile duct and intrahepatic stones.

Adult↗
PubMed1990

Simulation of gallstone fragments by cavitation bubbles during extracorporeal shock wave lithotripsy: physical basis and in vitro demonstration.

During extracorporeal shock wave lithotripsy of gallstones, sonography often shows a swirling pattern of echogenic foci shortly after the application of shock waves. This effect has been thought to represent gallstone fragments in suspension. However, evidence suggests that this finding is in part due to cavitation, a physical phenomenon associated with the formation or movement of gas bubbles in the fluid-filled gallbladder. Condoms filled with degassed water and five human bile specimens were positioned in the focus of an MPL 9000 lithotriptor (Dornier Medical Systems, Munich). A solitary nonradiopaque gallstone was then added to a bile-filled condom, and the sonographic pattern was observed before and after fragmentation. The mean clearance time of the cavitation bubbles was 4 seconds for degassed water and 22 seconds for human bile. Gallstone fragments were distinguished from cavitation bubbles by their prolonged settling time (up to 30 minutes) along the dependent gallbladder wall.

Bile↗
PubMed1990

[Reliability of the diagnosis of chronic pancreatitis].

Severe chronic pancreatitis can be easily diagnosed by means of pancreatic function tests and/or imaging procedures, whereas the mild form of the disease or its early stages are more difficult to detect and are often only retrospectively diagnosed. The reliability of imaging procedures depends mainly on the experience of the investigator, whereas the reliability of the pancreatic function tests depends on the patient's compliance. Further diagnostic procedures should be performed in accordance with the mayor symptom. If weight loss, diarrhea and/or steatorrhea dominate, indirect pancreatic function tests are required. Normal results of these tests usually exclude a pancreatogenic origin. If epigastric complaints dominate, ERCP should be performed prior to the indirect pancreatic function tests. If all findings are normal and all other upper abdominal diseases ruled out, but--due to persisting symptoms--chronic pancreatitis is still suspected, a direct function test should be performed to confirm or refute the tentative diagnosis. Chronic pancreatitis may--in its early stage--only involve the small pancreatitic ducts, not visible on ERCP examination, and indirect pancreatic function tests may show falsely normal test results.

Amylases↗
PubMed1990

[Epidemiology and predictability of variceal hemorrhage].

Up to 80% of patients with liver cirrhosis develop esophageal variceal bleeding which is lethal in up to 30% after the first bleeding episode. Parameters suitable to identify patients being on risk to bleed from their varices are severe liver disease (Child's C), large varices with red color sign and red wall markings and high intra-variceal pressure above 12 mmHg.

Blood Pressure↗
PubMed1990

Electromagnetic shock-wave lithotripsy of gallbladder calculi. Multicentered preliminary report on experience with 276 patients.

The Lithostar Working Group reports on the first 276 patients who underwent lithotripsy of biliary calculi by means of an electromagnetic Lithotriptor (Lithostar Plus from Siemens). Some 66% (183/276) and 27% (75/276) of the patients had solitary and two or three stones, respectively while 7% (18/276) had more than three gallbladder calculi. Calcified calculi were found in 11% of the patients. On an average the patients were treated in 1.6 (range 1.4-2.15) sessions; with the exception of one user the maximal energy (setting 9) was applied. The upper limit of shock waves per session was 1500-6000 (x = 2189 +/- 1058). 17% and 48% of the patients were free from calculi after 3 and 6 months, respectively. During the follow-up period 14% of the patients complained of severe biliary pain and 1.5% suffered from pancreatitis, which was controlled by conservative treatment. In three out of five patients with a transitory cholestatic jaundice endoscopic papillotomy was necessary. Four patients underwent an elective cholecystectomy. Considering the selection of the patients, the results obtained are comparable with those found in other studies.

Cholelithiasis↗
PubMed1990

[Esophageal endoscopy for the assessment of risk of hemorrhage of esophageal hemorrhage].

Haemorrhage from oesophageal varices is still a life-threatening complication of portal hypertension. Parameters which are suitable to identify patients being at risk to bleed are urgently required to decide which patients should be candidates for prophylactic therapy. Recent studies showed that only 18% of bleeders present with small, however 49.9% with large varices. 80% had red color sign of the variceal wall and significantly higher intravariceal hydrostatic pressure (21.9 mmHg vs 14.7 mmHg, p less than 0.001) than patients without previous haemorrhage. Advanced liver disease (Child's C) is an additional risk factor. However, the clinical value of the endoscopic parameters is limited by a significant overlap of variceal size and pressure obtained in bleeders and non-bleeders. Thus, only patients with small varices, (Grade I), low variceal pressure (below 12 mmHg), and fair condition are unlikely to develop variceal bleeding. A significant additional clinical value of the parameters is provided by the fact that they allow accurate definition of patients with portal hypertension particularly for further clinical studies.

Esophageal and Gastric Varices↗
PubMed1989

[Extracorporeal shockwave lithotripsy of gallstones: how many patients are suitable for it?].

The proportion of patients with gallbladder stones suitable for extracorporeal shockwave lithotripsy (ESWL) was analysed prospectively in 200 patients aged 17-76 years (62 males, 138 females) with symptomatic cholecystolithiasis. Criteria for inclusion were clinical symptoms, solitary stones (diameter 10-30 mm) or up to three stones with comparable total volume, contractile gallbladder, no calcification of stones, normal biliary tract anatomy. To check these criteria a step-by-step diagnostic procedure was instituted which consisted of history, ultrasonography with contractility test, abdominal X-ray film, computed tomography measurement of stone density, and endoscopic retrograde cholangiography. Only 19 patients fulfilled the criteria. The others had to be excluded because of history (35), stone size or number (73), impaired gallbladder contractility (27), calcified stone (30), pigment content (12), and/or biliary tract anatomy. Thus only a surprisingly small percentage (about 10%) of patients with symptomatic gallbladder stones is suitable for ESWL.

Adolescent↗
PubMed1989

[Duplex sonography of the portal vein. Procedure in healthy probands and patients with portal hypertension].

Duplex ultrasonography is a useful non-invasive means of investigating portal vein blood flow in cases of liver disease. A group of 50 selected consecutive patients with portal hypertension revealed a significant increase in portal vein diameter of 3.5 mm on average, and a significant decrease in mean flow rate of, on average, 3.1 cm/s, in comparison with a group of 50 healthy control subjects. In contrast, alcohol-induced portal hypertension appeared always to be associated with an elevated flow rate. On average, the flow volume increased by 200 ml/min. With the exception of vessel diameter, which remains virtually unchanged, both patients and controls revealed, postprandially, a comparable increase in the parameters measured.

Blood Flow Velocity↗
PubMed1989

[The results and complications of 616 percutaneous transhepatic biliary drainages].

During nine years, percutaneous transhepatic biliary drainage was carried out 616 times on 563 patients in the Department of Radiology, University of Mainz Medical School. 50.3% were pre-operative and 39% were palliative. More than 80% were necessitated by malignant lesions. Subsequent improvements in biochemical measurements were observed in 82.4% of patients. Complications of the procedure led to the death of five patients (0.8%) and required surgery in nine patients (1.5%). The following complications were observed: biliary peritonitis in 0.6%, sepsis in 1.9%, bleeding in 1.9% and fever higher than 38 degrees C in 16.2%.

Biliary Tract↗
PubMed1989

Electromagnetically generated extracorporeal shock waves for gallstone lithotripsy: in vitro experiments and clinical relevance.

First generation shock wave sources have been proved to disintegrate gallstones effectively, but they require the immersion of the patient's body in a tank of water. A recently developed second generation shock wave source (Siemens-Lithostar, Erlangen, FRG) generates shock waves electromagnetically. It presents several novel features. In particular the waterbath can be omitted and due to lower shock wave pressure general anaesthesia is not required. In vitro studies showed that 36 out of 38 gallstones (11-30 mm in diameter) could be disintegrated. Two concrements resisting lithotripsy were pure white cholesterol stones. Independent of shape, size, and composition (cholesterol or pigment) the maximum diameter of remaining fragments after lithotripsy was between 1 and 8 mm. For sufficient disintegration precise focusing (+/- 1 cm) of the stones and maximum power of the shock wave generator were required.

Cholelithiasis↗