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P Sungler

Publications and source records attributed to P Sungler.

At least 19 recordsLinked to original sources
PubMed2001

Immunohistochemical assessment of an asymptomatic glucagonoma in a patient with hypergastrinemia and marked antral angiodysplasia.

A 58-year-old patient had been treated for recurrent gastritis. Numerous gastroscopies indicated hemorrhagic gastritis combined with increasingly severe anemia. The patient was admitted with a hemoglobin of 4.4 g/dL. Gastroscopy showed marked antral angiodysplasia. Serum samples for gastrin were taken and found to be elevated (170-250 U/mL). The search for a gastrin-producing tumor with abdominal ultrasound, computed tomography, octreotide scan, and secretin test was negative, but angiography detected a pancreas tumor with a 2-cm diameter. Partial pancreatectomy and partial gastrectomy were performed. Immunohistochemical examination of the tumor did not show a gastrinoma but did show glucagon-reactive tissue. Further tumors or elevated plasma hormone levels were not detected, and a multiple endocrine neoplasia type I syndrome could be excluded. We thus found antral angiodysplasia with hypergastrinemia leading to detection of a glucagonoma diagnosed by immunohistochemistry. After more than 4 years of follow-up, the patient is without any symptoms or signs of relapse or secondary hormone syndrome.

Diagnosis, Differential↗
PubMed2000

Detecting the sentinel lymph node in patients with differentiated thyroid carcinoma.

The aim of this study was to evaluate sentinel lymph node mapping in patients with differentiated thyroid carcinoma. Nine patients with suspected thyroid carcinoma who were scheduled to undergo thyroidectomy underwent scintigraphic localization of sentinel lymph nodes (SLNs). On the day of surgery we injected 37 MBq technetium-99m nanocolloid intratumourally. Dynamic data up to 10 min followed by planar anterior and lateral oblique images up to 1 h after tracer administration were recorded. At surgery the primary tumour was excised first, then the SLNs were removed using a gamma probe. Four patients had papillary carcinoma, two follicular carcinoma, one an oncocytic tumour and two benign tumours. An SLN was identified in all four patients with papillary carcinoma. In the two patients with follicular carcinoma, SLN detection failed. Five patients had one radioactive node, one had three and one had four. In one patient, no SLN was visible with scintigraphic imaging but at surgery three SLNs could be clearly identified using the gamma probe after removal of the primary tumour. There were no false-negative findings. This initial study indicates that in patients with papillary thyroid carcinoma detection of the SLN is possible, whereas the technique failed in two patients with follicular carcinoma. A study on a larger patient sample is now warranted.

Adult↗
PubMed2000

Laparoscopic cholecystectomy and interventional endoscopy for gallstone complications during pregnancy.

BACKGROUND: Symptomatic or complicated gallstone disease is the most common reason for nongynecological operations during pregnancy. Gallstones are present in 12% of all pregnancies, and more than one-third of patients fail medical treatment and therefore require surgical endoscopy or laparoscopy. Gallstone pancreatitis and jaundice during pregnancy is associated with a high recurrence rate, exposing both fetus and mother to an increased risk of morbidity and mortality. METHODS: During a 4-year period, all pregnant patients (n = 37) with symptomatic or complicated gallstone disease were studied prospectively at the Landeskrankenhaus in Salzburg, Austria. Five patients had an endoscopic retrograde cholangiopancreatogram (ERCP) for biliary pancreatitis or jaundice; two of these underwent subsequent laparoscopic cholecystectomy. Another seven patients required laparoscopic cholecystectomy for severe pain or cholecystitis; all were in their 13th-32nd gestational week. Access was established by Veress needle in all cases. Insufflation pressure was 8-10 mm Hg, and mean operative time was 62 min. RESULTS: All patients delivered full-term, healthy babies. There were no postendoscopic or postoperative complications. All patients enjoyed full relief from their symptoms; there were no recurrences of pancreatitis or jaundice. CONCLUSIONS: The combination of ERCP and laparoscopic cholecystectomy offers a safe and effective option for the definitive treatment of complicated gallstone disease and intractable pain during pregnancy, and there is sufficient access for the combined treatment to be employed.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1997

EAES ductal stone study.

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Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1997

[Preoperative therapeutic splitting].

INTRODUCTION: The best clinical strategy for using ERC combined with LC is still unknown. Based on a wide discussion of literature reports the aim of our study is to critically analyse laparoscopic bile duct exploration and to correlate these data to our prospective study of "therapeutical splitting". PATIENTS AND METHODS: In a prospective study 1645 consecutive patients with sympomatic gall stone disease were examined by ultrasound. 309 patients had open cholecystectomy because of previous gastric surgery or perforation. Patients with a high probability of harbouring stones in the common duct or having other related disorders like biliary pancreatitis had ERC, EPT and stone extraction. 1336 patients had attempted LC. RESULTS: At endoscopy 70% of the 260 patients required therapy like EPT and/or stone extraction, 95% consequently had their gallbladder removed laparoscopically. Including the patients with biliary pancreatitis morbidity amounted to 3% with no mortality. In the non-endoscopic group with 1076 patients conversion was 6.8%, morbidity was 4.3% and mortality 0.09%. Residual stones were found in 0.5% so far. CONCLUSION: If selection criteria for bile duct pathology have a high sensitivity and specificity and endoscopical stone clearance rate is high, at present "therapeutical splitting" still is the method of choice.

Adolescent↗
PubMed1997

[Treatment of postoperative bile fistulas after laparoscopic cholecystectomy by ERCP, EPT and bile duct drainage].

BACKGROUND: Bile leakage as a complication following cholecystectomy can be found more frequently after laparoscopic cholecystectomy (LC) than after open cholecystectomy. The present study planned to find out the importance of ERCP, sphincterotomy and temporary drainage of the bile duct system in the treatment of bile leakage. PATIENTS AND METHODS: From July 1992 to October 1996 15 consecutive patients presenting with bile leakage following LC underwent endoscopic therapy by CBD-drainage with sphincterotomy (n = 11), CBD-drainage without sphincterotomy (n = 1) and sphincterotomy alone (n = 3). RESULTS: Closure of the bile leakage could be achieved in all cases, biliary secretion stopped after 2.1 days (1-7 days). One dislocation of the drainage into the CBD was found and could be treated endoscopically. Endoscopy-related mortality was 0%. CONCLUSIONS: Endoscopic therapy offers a safe, effective and minimal invasive method in the treatment of bile leakage following LC.

Adult↗
PubMed1997

[Urgent ERCP and early elective laparoscopic cholecystectomy in biliary pancreatitis].

BACKGROUND: For many years the best algorithm of treatment for complicated gallstone disease has been intensively discussed. Gallstone pancreatitis with cholangitis still belongs to the most often identified causes of death of necrotizing pancreatitis. The reduction of complication and lethality rates was mainly achieved by urgent ERCP and sequential cholecystectomy. In a prospective study we have combined endoscopic therapy with laparoscopic cholecystectomy (LC) and are discussing the results. PATIENTS AND METHODS: Between May 1991 and December 1996 146 patients with biliary pancreatitis were subjected to ERCP after laboratory tests and ultrasound screening of the biliary system. If there were no contraindications and the gallbladder was still in situ, LC was attempted during the initial admission. RESULTS: Of the 70 patients with attempted LC 26 had common bile duct calculi, 23 had an impacted papillary stone and 10 had signs of a stone passage. 59 patients underwent LC successfully, a conversion to open surgery was necessary in 11 patients. The morbidity rate amounted to 7%, lethality to 0%. DISCUSSION: Since a more liberal indication for ERCP in the management of acute pancreatitis was introduced the number of biliary related cases of acute pancreatitis is increasing. In response to early endoscopic bile duct clearance the rates of morbidity and mortality can be significantly reduced. Early LC is the ideal complementary treatment option to absolutely prevent recurrencies.

Adult↗
PubMed1997

[Value of diagnostic laparoscopy and minimal invasive procedures in acute abdomen].

During the last three years 172 diagnostic laparoscopies (DL) were performed at our department in patients with an acute abdomen of unclear causes. This corresponds to 17% of all patients who underwent operation due to an acute abdomen in the same period. Always the indication for a diagnostic laparoscopy arose then, when the cause or the localization of the acute abdomen could not be found by conventional diagnostic methods. The advantages of DL were either the confirmation (93%) or the exclusion (7%) of the diagnosis "acute abdomen", the exact localization and simultaneously a definitive operative treatment of the cause by minimal invasive interventions (n = 109/65%). In these patients with acute abdomen the main causes were acute inflammations of gallbladder (n = 48) and appendix (n = 29), ulcus perforations (n = 9) and ileus (n = 9). The conversion rate amounted to 2.7%, the postoperative complication rate to 11% and the lethality rate to 1.8% in these patients. A new indication is the so-called "bedside laparoscopy" as means to control the postoperative course of mesenteric embolism (n = 9) and diffuse peritonitis (n = 3) in order to avoid the stress of a second-look operation for these seriously ill patients or to secure the indication for relaparotomy.

Abdomen, Acute↗
PubMed1997

[Bedside laparoscopy (BSL) for postoperative follow-up of mesenteric infarct and diffuse peritonitis].

Bedside laparoscopy (BSL) for postoperative follow-up in mesenterial infarction of the intensive care patient undergoing respiration treatment represents an important tool for avoiding second-look operations and/or for precisely securing the indication for a relaparotomy. Up until now, nine patients with mesenterial infarction have undergone a BSL, allowing five of then to avoid a second-look operation in this way. Of these nine patients, three died due to a diffuse peritonitis with anastomotic dehiscence, a pulmonary embolism, and a perforation of the stomach after PEG tube deplacement, respectively. Thus BSL represents a low-complication and simply performed method for postoperative follow-up, especially in mesenterial infarction, but also in cases of diffuse peritonitis.

Cause of Death↗
PubMed1997

[Potential for improvement of combined endoscopic-surgical treatment of bleeding gastroduodenal ulcer].

A total of 119 patients (January 1995-December 1996; 53 women, 66 men) with a medium age of 63.1 years were admitted to hospital with bleeding gastroduodenal ulcer. Emergency gastroduodenoscopy was performed immediately in all cases, sclerotherapy in 94 cases (78.9%). Control endoscopy was done routinely after 12-24 h; the recurrent bleeding rate amounted to 14.3%, mortality was 5%, and surgical intervention was necessary in 8.4% with a mortality of 40% (!).

Adolescent↗
PubMed1994

[Choledocholithiasis--therapeutic splitting].

Despite new developments like chemolitholysis and extracorporeal shock wave lithotripsy, conventional cholecystectomy was the "gold standard" in the treatment of gallstones. The range of indications and the operative strategy were well standardized, although the management of common bile duct stones in gallstone disease was still under debate. For high-risk and elder patients endoscopic retrograde cholangio-pancreatography (ERCP), papillotomy and stone extraction was established, in younger patients the best management was questionable. According to better and more accurate preoperative tests like ultrasound and the ample evidence of the function of the papilla after endoscopic papillotomy the trend seemed to be the preoperative endoscopic bile duct clearance in all patients, just when the "bushfire" of laparoscopic cholecystectomy arised and until then praised standards were thrown overboard because of technical difficulties. Routine intraoperative cholangiography (IOC) was replaced by indicated selective IOC due to the lack of talent of many surgeons. Only the therapeutic concept of the removal of the stone-bearing gallbladder survived all new concepts and the debate of whether to perform routine IOC and whether to clear the bile ducts--pre-, intra- or postoperatively or primarily or secondarily convert to open cholecystectomy and bile duct revision. In the eye of a new "gold standard" and according to the literature and our own results we should standardize our management especially in the era of laparoscopic cholecystectomy as "therapeutical splitting" with indicated and selective preoperative ERCP and bile duct clearance offers the best results and facilitates minimally invasive surgery.

Adult↗
PubMed1993

[Laparoscopic cholecystectomy in cholecysto-choledocholithiasis. "Therapeutic splitting" or conventional surgical procedure?].

In a prospective study the impact of preoperative, selective endoscopic cholangiography (ERC/P) and therapy was evaluated in 586 consecutive patients with symptomatic gallstone disease in respect of biliary pathology and laparoscopic cholecystectomy (n = 520). Exclusion criteria for the admission to the study were previous gastric surgery, necrotizing cholecystitis and gallbladder perforation. Because of presumed pathology on ultrasound, suggestive for common bile duct stones or papillary stenosis 59 patients (11.3%) had preoperative ERC/P. In all patients with calculi (n = 40) endoscopic stone removal was successfully performed with/without sphincterotomy (EPT), in three cases of clinically relevant stenosis EPT was indicated. Morbidity was 1.6% after ERC/EPT, in the endoscopic group operative morbidity and mortality was zero. In the non-endoscopic group (n = 461) sixteen complications occurred, although none could have been avoided by preoperative cholangiography. Two patients showed retained calculi (0.3%), missed by preoperative diagnostics. Both cases were successfully treated by ERC. Intraoperative cholangiograms were not done routinely (11%). In conclusion, we think, that selective, preoperative ERC/P, EPT and stone removal--if necessary--facilitate a very low morbidity and mortality in the laparoscopic treatment of complicated gallstone disease. By means of the "therapeutical splitting" the conversion to open bile duct surgery with all its higher morbidity and mortality can be eradicated. Also, only a few of the endoscopically operating hospitals already provide equipment for laparoscopic bile duct revision, not to talk about the gifted and experienced surgeons.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Laparoastoma (open packing) in the treatment concept of infected pancreatic necroses].

Out of 284 patients with acute pancreatitis 73 (26%) had pancreas necrosis. Of these 73 cases 43 patients with infected pancreas necrosis were treated surgically, whereas conservative treatment proved successful in the remaining 30 cases with so-called sterile necrosis. Our interdisciplinary treatment combined delayed surgery for the better demarcation of the necrotic tissue, with extended intensive care therapy and epigastral laparostomy; through this laparostomy surgical revision with necrosectomy and peritoneal lavage was performed daily for 15 (+/- 6) days, necessitating long-term artificial respiration for an average of 15 (4/168) days. The mortality rate in the 43 patients with infected pancreas necrosis amounted to 16.2% (n = 7); none of the patients with sterile necrosis died. In cases of multiple organ failure the mortality rate was significantly higher (30%) than with failure of only one organ system (4.3%). The mortality rate in all cases with pancreas necrosis (n = 73) amounted therefore to 9.5%. Serious complications of laparostomy occurred in 28% (n = 12) of the 43 patients, whereby 8 of these cases were gastrointestinal fistulae, with a fatal outcome in one patient. The overall mortality rate in the total group of 284 patients with acute pancreatitis was 2.8%.

Acute Disease↗
PubMed1992

[A combined endoscopic surgical treatment concept in acute biliary pancreatitis].

This paper presents the results of a combined endoscopic-surgical approach with management of acute biliary pancreatitis in 91 patients. The diagnosis was always made by means of endoscopic-retrograde cholangiography. Papillary or bile duct stones, or unmistakable signs of previous stone passage, and in exceptional cases flow obstruction due to preiampullary diverticuli were considered criteria for a positive diagnosis. All 91 patients were subjected to endoscopic sphincterotomy with/without stone extraction subsequent to the diagnostic cholangiogram. Endoscopic intervention was performed as soon as possible after admission to hospital, but by 48 hours at the latest. Cholecystectomy was carried out in all patients who were free of risk factors and without previous cholecystectomy, during the disease-free interval. The complication rate of this combined endoscopic-surgical approach amounted to 10.9%; the mortality rate was 3.3%. The achieved results suggest that endoscopic sphincterotomy with stone extraction in the acute phase of biliary pancreatitis is the method of choice in order to interrupt the process of this disease. In combination with the final surgical treatment of gallstone disease by cholecystectomy to avoid recurrences, the prognosis of acute biliary pancreatitis can be significantly improved by using this combined endoscopic-surgical management.

Adult↗
PubMed1992

[Extracorporeal shock wave treatment of calcium containing gallbladder calculi].

A total of 50 patients--37 female and 13 male--with an average age of 50 +/- 27 years (23-86 years), suffering from rim-calcified gallbladder stones, underwent extracorporeal shock-wave lithotripsy (ESWL), using an ultrasound-guided overhead module of Lithostar Plus (Siemens Company). The total number of stones was 87, with an average diameter of 16 +/- 7 (7-38) mm. 29 patients had a solitary stone, 13 had two and 8 patients three or more stones. All patients received adjunct medication of 10 mg/kg body weight chenodeoxycholic and ursodeoxycholic acid 14 days prior to ESWL as a single bedtime dose. An average number of 5,300 +/- 2,200 shock waves (1,200-15,000) was applied for stone disintegration. The corresponding energy amounted to 750 bar. 29 patients needed one, 21 two or more treatments. After ESWL a variety of clinical abnormalities was observed: flank pain (15%), transient microhaematuria (33%) and transient macrohaematuria (2%). Subsequent to ESWL 5 patients suffered from complications such as biliary obstruction 3 weeks to 9 months after treatment and had to undergo ERCP. Three times endoscopic papillotomy was performed to remove stones from the common bile duct. Up to now 4 patients have undergone cholecystectomy: acute cholecystitis (n = 3), recurrent colicky pain (n = 1). 20 patients have been followed up over a 12-month period; 12 of them are completely free of stones and fragments.

Adult↗