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Biomedical subjects

P C Lederer

Publications and source records attributed to P C Lederer.

At least 19 recordsLinked to original sources
PubMed1991

Esophageal visible vessel as a cause of massive upper gastrointestinal hemorrhage.

Besides peptic ulcers, erosions, esophageal varices, tumors and non-variceal esophageal lesions, vascular abnormalities lead to an upper gastrointestinal hemorrhage in 1-5% of cases. Among 581 emergency esophagogastro-duodenoscopies for acute gastrointestinal bleeding performed in our institution between 1987 and 1989, an esophageal visible vessel was found to be the source of massive hemorrhage in five patients. All patients were males with ages ranging from 37 to 84 years. Esophageal visible vessel was localized in one patient in the middle third and in four patients in the distal portion of the esophagus. Using the Forrest classification, endoscopy revealed an oozing hemorrhage (Ib) in two patients and a protruding vessel (IIa) in three patients. Definitive hemostasis could be achieved in all patients by local injection of adrenaline combined with heater probe thermocoagulation. In some patients with recurrent upper gastrointestinal bleeding, visible esophageal vessel is a rare source of bleeding that has not yet been described.

Adult↗
PubMed1990

[Gastroesophageal reflux disease].

Gastro-esophageal reflux disease is primarily a functional disorder. Morphological manifestations occur secondarily. Primary functional changes include spontaneous relaxation and insufficiency of the lower esophageal sphincter, delayed gastric emptying and impaired esophageal peristalsis. The diagnosis is established by endoscopy--in special cases by pH-metry. Therapy comprises general measures and specific drug treatment with H2-blockers, omeprazole and prokinetics. Prophylaxis of recurrence is a problem that remains to be solved.

Esophagitis, Peptic↗
PubMed1990

Endoscopic management of malignant biliary obstruction and recurrent cholangitis with a self-expanding prosthesis.

Endoscopic implantation of a prosthesis usually provides effective palliation in malignant biliary obstruction and in some cases of benign strictures. The most common problem concerning stent patency is occlusion, which may lead on to cholangitis and septic complications. A new technique employing self-expanding stents offers encouraging results. Preliminary clinical experience with expanding biliary stents are reported. The expectations of the doctor and patient, and the preferences and advantages of this new method are discussed on the basis of a case report with recurrent septic complications caused by conventional biliary prosthesis.

Aged↗
PubMed1990

[Myelolipoma of the adrenal gland].

Myelolipomas of the adrenal gland are rare, nonfunctioning and benign tumors. The etiologic feature of these tumors, composed of fat and hematopoietic elements, remains unclear. Usually, myelolipomas of the adrenal gland, which are mostly asymptomatic, are recognized incidentally. Sonographic demonstration of the hyperechoic tumor combined with fine-needle aspiration biopsy reveals a prompt diagnosis. Computed tomography and adrenal angiography are complementary techniques. In most of the cases, a surgical treatment is indicated if the tumor becomes evidently symptomatic.

Adrenal Gland Neoplasms↗
PubMed1990

[Annular pancreas--a congenital abnormality of the pancreas].

Our case report on a 26-year-old male suffering from epigastric pain for several years should emphasize the fact, that even a rare congenital malformation like the annular pancreas must seriously discussed as a reason for the so called unspecific abdominal pain. Embryological development, age of manifestation, symptoms and therapeutic concepts are described. The importance of endoscopic methods such as gastroduodenal endoscopy and endoscopic retrograde cholangiopancreatography (ERCP) for a more precise and frequent diagnosis will be strengthened and the influence on the prevalence will be discussed.

Adult↗
PubMed1987

[Drugs modifying motility in ulcer therapy].

The outstanding success of H2-blocking agents in ulcer therapy proves gastric acid as a dominating factor in the pathogenesis of ulcers. Motility disturbances can be demonstrated in ulcer patients but up to now in therapeutic terms played only a minor role. The therapeutic success of the antimuscarinic drug pirenzepine which inhibits only gastric secretory volume without influencing gastric pH but exerting a significant influence on interdigestive motility of the upper gastrointestinal tract reestablishes this factor to be of pathogenetic relevance. The pathophysiological factor of motility disturbances in the etiology of gastric ulcers is stressed also by the results of a recent therapeutic study comparing ranitidine and cisapride, where the motility-stimulating benzamide showed exactly the same rate of success as the H2-blocker; this holds true for both healing rate and symptomatic improvement. Therefore as far as chronic gastric ulcer is concerned a combination therapy should be preferred thus avoiding the side-effects of a strong and long lasting suppression of gastric acid secretion.

Cisapride↗
PubMed1986

Treatment of duodenal ulcer with low-dose antacids.

The aim of the present investigation was to compare the efficacy of a low-dose antacid (Maalox 70, 280 mmol/day) with that of the H2-receptor antagonist cimetidine (Tagamet, 200 mg three times daily and 400 mg/day) after 14 and 28 days in the treatment of duodenal ulcer. The prospective multicentre study included 171 patients with endoscopically confirmed duodenal ulcers. The patients were randomly assigned to the treatment groups with antacid containing Mg and Al hydroxide (M)(4 X 70 mmol/day; n = 86) or to the group receiving cimetidine (T) (1000 mg/day; n = 85). The two treatment groups were matched for age, sex, drinking and smoking habits, and drug use. Endoscopic examinations were carried out before the start of treatment and 14 days later. If the ulcer was still present at this time, the second endoscopic examination was done after a further 14 days. Endoscopically, the ulcer had healed at 14 days in 38.8% (M) and in 34.9% (T) and at 28 days in 80.0% (M) and 74.7% (T), respectively. The healing rate did not differ significantly between the two treatment groups. Complaints, measured as percentage of days per week with upper abdominal pain, were significantly reduced in both groups. No significant differences were found between the two treatment groups with regard to pain relief or side effects. Treatment had to be abandoned in one patient receiving antacid because of diarrhoea and in one patient receiving cimetidine because of the absence of any response.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Control of gastrointestinal motility and secretion by gastrointestinal peptides].

Cyclic pattern of interdigestive motility and of plasma levels of motilin, somatostatin and pancreatic peptide (PP) show close relationship. During interdigestive state gastric and lower esophageal motility seems to be mediated by pulsatile release of motilin, whereas the motor activity of duodenum seems to be controlled by somatostatin. Disturbed interdigestive motility could be demonstrated in gastrointestinal diseases like bacterial overgrowth, sclerodermia, post-vagotomy diarrhea and reflux esophagitis.

Diarrhea↗
PubMed1984

[The irritable colon].

Gut dysfunction can be demonstrated in 20-30% of normal adults without ever developing real illness. Irritable bowel syndrome is not merely a gastrointestinal disturbance, but involves the whole organism. With respect to etiology a number of factors such as constitution, mental state and environment, colonic motility, gastrointestinal peptides, low residue diet, food intolerance and infections all seem to play a role. Positive diagnosis by electromyography has not gained any clinical relevance. Treatment of gastrointestinal functional disorders is characterized by a considerable positive response to placebo and is oriented towards individual symptoms. Bran and bulking agents are effective when constipation is present, opiate-agonists have a positive influence in diarrhoea, anti-cholinergics may be of some value in abdominal pain, antidepressants and sedatives given for a limited period of time may be beneficial in psychiatric symptoms. The combination most often used in therapy of irritable bowel syndrome consists of sedatives, anticholinergics and bulking agents. Psychotherapy can prolong the positive effects of medical therapy even beyond the treatment period. Long-term follow-up reveals a satisfactory response of the symptomatology in the majority of patients.

Adult↗
PubMed1982

Influence of atropine, pirenzepine and cimetidine on nocturnal gastro-intestinal motility and gastric acid secretion.

The present study was performed to investigate the correlation between gastric H-ion-concentration and interdigestive motility (1) under basal conditions and (2) under the influence of pirenzepine, atropine and cimetidine. During the control period 6.5 (DZ1 5, DZ9 12) MMC's per 12-hour periods (69 +/- 7% gastrointestinal MMC's) were recorded. After administration of pirenzepine and the combination of pirenzepine and cimetidine almost exclusively gastrointestinal MMC's could be identified. On the other hand, atropine did not change the gastrointestinal/intestinal MMC ratio, but reduced total number of MMC's significancy (p less than 0.05). Percentage of observation time with antral pH greater than 4 was significantly increased by the combination of pirenzepine and cimetidine, but not by pirenzepine or cimetidine alone nor by atropine. There was a positive correlation between interdigestive cycle-length and percentage of time with antral pH greater than 4. The effect of pirenzepine on interdigestive motility (1) seems not to be mediated by the inhibition of gastric acid and (2) is different from the effect of atropine.

Adult↗