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Biomedical subjects

R Pointner

Publications and source records attributed to R Pointner.

At least 55 records · Page 3Linked to original sources
PubMed1994

Traumatic bilhemia.

BACKGROUND: Retrospective analysis was done of three cases with severe liver trauma and excessive serum bilirubin levels caused by a traumatic biliovenous fistula. The literature is reviewed. METHODS: Diagnostic measures included laboratory findings, computed tomography, ultrasonography, and endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: The biliovenous fistula was detected by ERCP in two cases. In one case a left hemihepatectomy was carried out, and the patient was cured. The other patient received drainage of a huge necrotic cavity in the center of the liver. Ten months later the patient underwent reoperation, and left hepatic resection was performed. The patient died of liver function failure on postoperative day 7. In the third case the fistula subsided spontaneously. CONCLUSIONS: An excessively high serum level of direct bilirubin and only moderately elevated liver enzymes indicate bilhemia in trauma patients. ERCP is most reliable in localizing the fistula; computed tomography/ultrasonography are valuable in detecting the extension and localization of the parenchymal destruction. Conservative therapy is justified if the patient is in good condition or if the localization of the fistula is unclear. Spontaneous closure of the fistula may occur. Surgical treatment options are partial liver resection and suture of the fistula and T-tube drainage of the common bile duct and drainage of the rupture site.

Adolescent↗
PubMed1992

Primary squamous cell carcinoma of the stomach in a seventeen-year-old boy.

Primary squamous cell carcinoma (SCC) of the stomach is extremely rare and thought to arise from ectopic squamous epithelium, which in turn could either result from the squamous metaplasia of the gastric mucosa or be congenital in origin. We report herein a case of SCC of the stomach in a 17-year-old male, who died 1 year after undergoing a gastrectomy. To our knowledge, this is the youngest case of primary SCC of the stomach reported in the literature. Further speculative possibilities of the development of primary gastric SCC are discussed following the presentation of this case.

Adolescent↗
PubMed1992

Treatment of calculi of the common bile duct.

Endoscopic sphincterotomy (EST) is regarded as an alternative therapeutic approach to the surgical treatment of choledocholithiasis. To clarify the indication for each of these two methods, a prospective study has been performed comparing patients with calculi of the common bile duct who had undergone endoscopic or surgical treatment. Mortality, morbidity and stone clearance were used as criteria for the evaluation of the dependence of age on results achieved by the two modalities. Of 306 patients with choledocholithiasis, 199 underwent surgical exploration of the duct and 107 underwent endoscopic sphincterotomy. Patients who were more than 60 years of age and had previously undergone cholecystectomy underwent endoscopic sphincterotomy. All other patients had surgical treatment. There were no significant differences among the two groups with regard to mortality rates. The incidence of relevant complications as well as the incidence of surgical revisions related to postoperative complications in the operation group was, however, significantly higher (p less than 0.05). In contrast with this, the incidence of retained stones was significantly lower (p less than 0.01) in the group that underwent surgical treatment (2.5 percent) than in the group that had endoscopy (11.2 percent). When assessing the results in terms of stone clearance, complications and mortality rates, findings seem to indicate that a safe limit for the application of surgical treatment would be 60 years of age, whereas older patients should be primarily considered as candidates for EST.

Age Factors↗
PubMed1989

[Endoscopic sclerotherapy of bleeding Mallory-Weiss mucosal tear].

Based on a review of 66 patients with the Mallory-Weiss syndrome, the problems of diagnosis and treatment in general, and the application of sclerotherapy in particular in patients with bleeding tears is discussed. At emergency endoscopy 32 patients (48.4%) had an acute bleeding episode which could be stopped by sclerotherapy in 26 of 27 cases. The importance of control endoscopy after 48 hours and its influence on prognosis are emphasized.

Adolescent↗
PubMed1989

[Tumor markers in the upper intestinal tract--stomach and pancreas].

Expectations of early diagnosis of carcinoma of the stomach and pancreas by using the tumour markers CEA and CA 19-9 have been disappointed. Although the sensitivity of CA 19-9 for pancreatic cancer is high, its field of application for screening is not efficient due to poor specificity of the marker. CEA and CA 19-9 are of great importance in the follow-up of pancreatic cancer. Results of tests of CEA and CA 19-9 in 100 patients with gastric cancer and 50 patients suffering from pancreatic cancer are reported.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1989

Colonoscopic treatment of sigmoid volvulus.

Sigmoid volvulus commonly presents with signs of bowel obstruction. In the absence of an exact preoperative diagnosis, these patients have to undergo urgent surgery. We report a case of sigmoid volvulus diagnosed radiologically and managed by endoscopic derotation. When the cause of the obstruction is known to be due to sigmoid volvulus, surgery can be avoided by careful endoscopic derotation of the sigmoid colon.

Adult↗
PubMed1989

"Reversible gastric banding" in surgical treatment of morbid obesity--results of animal experiments.

The basic principle of "reversible gastric banding" as a new surgical approach to morbid obesity treatment is the creation of a small fundus reservoir using a silicone cuff which is coiled around the stomach close to the cardia. The extent of obstruction corresponds to the amount of liquid in the cuff which can be varied by puncture of a valve implanted in the subcutis. The reversibility of gastric obstruction is the great advantage of this method as compared to vertical banded gastroplasty or gastric bypass. We studied this method in animal experiments using seven "Göttinger Minipigs". In two animals the objectives of the study were reached, the observed complications, mostly caused by the nature of the test animal, are analyzed and discussed. To our knowledge, this is the first report in the literature on animal experiments in bariatric surgery.

Animals↗
PubMed1989

Endoscopic removal of a pedunculated bronchial lipoma by means of the hot snare.

The complete endoscopic removal by means of the hot snare of a pedunculated bronchial lipoma with a carcinoma in situ in its covering bronchial epithelium is reported. To our knowledge, the endoscopic removal of peripheral polypoid bronchial lesions has not been reported to date. The advantage of this technique lies in its ability to permit an exact histologic examination of the lesion, in contrast to laser vaporisation.

Aged↗
PubMed1989

Gastric stump cancer: etiopathological and clinical aspects.

Between 1959 and 1987, at the Innsbruck University Hospital, 359 cases of carcinoma were diagnosed in the gastric remnant. While until 1975 in 203 patients suffering from stump carcinoma the tumor stages T3 and T4 were significantly prevalent, a strong tendency towards the less advanced tumor stages T1 and T2 was observed in the last decade. Among 94 patients operated on since 1981 the tumor was located at the anastomosis in all but 5 cases, suggesting a strong connection between previous resection and stump carcinoma. In accordance with Lauren's classification no difference was found in the incidence of intestinal and diffuse lesions in 94 cases with stump carcinoma--in contrast to 69 cases of patients with a non-resected stomach. An analysis of the occurrence of acidity, atrophic gastritis and bacterial invasion in 70 patients with previous Billroth II resection and 30 patients with Billroth I resection, revealed no difference between the two types of resection. Gastric remnant carcinoma does not occur exclusively in the Bilroth II remnant, but, increasingly, following Billroth I operations. The finding of a statistically highly significant increase at the 5% level using standard chi 2-technique for a 2 x 5 table in stump carcinomas following Billroth I resections supports the thesis that there is no difference in the etiopathology of carcinogenesis in the Billroth I as compared with the Billroth II remnant.

Aged↗
PubMed1989

["Brown bowel" syndrome--lipofuscinosis of the intestine as a cause of atonia].

We report on a 42 year old male patient having been ill with pseudo-pobstruction and gastroinstestinal atonid for 24 years. He was thought to suffer from Crohn's disease and was treated conservatively. Since the therapy proved to be insufficient, explorative laparatomie was performed and parts of the small and large intestine which were thought to be inflamed, were removed. The histologic examination revealed the deposition of a significant amount of lipofuscin in the muscularis propria. This so-called brown bowel syndrome is known to be responsible for the development of gastrointestinal atonia. It is generally believed that this syndrome is caused by a vitamin E deficiency which may occur due to malabsorption. The brown bowel syndrome is treated sympomatically, and until now only one case achieving a remission of the disease has been reported.

Adult↗
PubMed1988

Endoscopic treatment of Dieulafoy's disease.

The "exulceratio simplex Dieulafoy" is an uncommon and dangerous cause of upper gastrointestinal hemorrhage. In all patients admitted to our hospital with signs of acute gastrointestinal hemorrhage in whom Dieulafoy's disease was diagnosed at emergency endoscopy, an attempt was made to stop the bleeding or to prevent further hemorrhage by local injection of polidocanol, or by bipolar electrocoagulation, or by a combination of both. Since 1979 an exulceratio simplex has been diagnosed in 22 patients. All patients were treated endoscopically, 18 of them with satisfactory results. Four patients had to be operated on after emergency endoscopy had failed. Knowing the location of the bleeding site, the operations could be planned exactly and performed quickly. All patients, whether they had undergone endoscopic or surgical treatment, made an uncomplicated recovery and none had a further bleeding episode after discharge from the hospital.

Adult↗
PubMed1988

Early cancer of the gastric remnant.

Early carcinoma of the gastric remnant was diagnosed in 19 patients between January 1976 and January 1986. In all patients early cancer was suspected at endoscopy and confirmed by biopsy and histology. The main reason for endoscopic examination was diffuse epigastric pain suggestive of stump gastritis. The surgical procedure was stump gastrectomy. Two of the 19 patients were not operated on because of advanced age. In contrast with the poor prognosis of patients with cancers of the gastric remnant of tumour stages T2 to T4 according to the TNM-classification regardless of their NM-stage, patients with tumour stage T1N0 and T1N1 have a good prognosis.

Adult↗