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Biomedical subjects

T Rösch

Publications and source records attributed to T Rösch.

At least 163 records · Page 9Linked to original sources
PubMed1991

[Indications and value of endosonography of the upper gastrointestinal tract].

Endoscopic ultrasound (EUS) has been used in the diagnosis and staging of gastroenterologic tumors for about ten years. High accuracy rates of EUS in staging of esophageal, gastric and pancreatic carcinoma (T-stage: 80-95%, N-stage: 75-85%) have been reported. EUS is therefore a valuable diagnostic tool für assessment of prognosis as well as for planning of therapy of these tumors. Its value in benign gastroenterologic disease is unclear. EUS seems to be much less reliable in the differentiation between benign and malignant changes (e.g. esophageal stenoses, gastric ulcers, pancreatic mass lesions).

Bile Duct Neoplasms↗
PubMed1991

[Endosonography in the differential diagnosis of dysphagia].

Endosonography makes it possible to judge the normal and the pathologically altered wall of the upper digestive tract. At the tip of a duodenoscope with lateral view there is a mechanical sector scanner with a visual angle of 360 degrees. Owing to its high power of resolution five layers of different echogenicity can be differentiated. The inner echo-rich and echo-poor layer corresponds to the mucosa and the muscularis mucosae, the intermediate echo-rich layer to the submucosa. The outer echo-poor layer can be attributed to the tunica muscularis, the outer echo-rich layer represents either the border echo or adventitial tissue. Thickening of the wall, inhomogeneous structure of the echo and infiltration of the outer wall contour are considered pathological. Indications for endosonography are essentially the judgement of tumours in the framework of tumour staging and the detection of paraesophageal lymph nodes. Furthermore the detection of submucosal and extramural lesions such as lymphomata, leiomyomata and intra- and extramural varices is possible. In the diagnostics of dysphagia endosonography should be applied in all cases where other established procedures of morphological and functional diagnostics do not clarify the situation or where they result in the suspicion of small intra- or extramural lesions of the esophagus. Within the framework of tumor staging, endosonography is indispensable.

Deglutition Disorders↗
PubMed1991

[Endoscopic ultrasound in small pancreatic tumors].

32 of 89 pancreatic tumors examined by endoscopic ultrasonography (EUS) from January 1986 to February 1990 had a diameter of 3 cm or less. The final diagnosis of a malignant (n = 28) or benign (n = 4) pancreatic neoplasma was achieved by operation, puncture or autopsy. The accuracy of EUS (100%) was higher than for ultrasound (61%), computed tomography (64%) or endoscopic-retrograde cholangiopancreatography (84%). The echopattern of the small pancreatic carcinomas showed, compared to larger neoplasms, less often regressive changes (21 vs. 77%) and a well demarcated or smooth tumor margin (25 vs. 2%). However, it is not possible to differentiate reliably a small malignant from a benign pancreatic tumor by the echofeatures alone. Since most pancreatic tumors are large at the time of clinical presentation, they can be visualized by conventional imaging methods in most cases. EUS adds clinically important information to the diagnosis of pancreatic carcinoma especially in small tumors.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

[Endosonographic diagnosis of pancreatic tumors].

140 patients (72 men, 68 women; mean age 57 [26-83] years) with suspected pancreatic tumours were investigated by endoscopic ultrasound (EUS) and also by conventional ultrasound, computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP). The EUS scans were performed with an echo-endoscope in the descending part of the duodenum (for the head of the pancreas) or in the stomach (for the body and tail). The definitive diagnosis or exclusion of a pancreatic tumour (malignant n = 85, benign n = 4, inflammatory n = 23, no tumour n = 28) was made at operation (n = 63), by needle biopsy (n = 35), at necropsy (n = 4) or by clinical follow up (n = 38, mean 10.5 months). The sensitivity and specificity of endoscopic ultrasound (99% and 100%) were superior to the results given by conventional ultrasound scans (71% and 39%), CT (82% and 46%) and ERCP (89% and 64%). This was also true of small tumours of 3 cm or less (EUS 100%, conventional ultrasound 57%, CT 68% and ERCP 89%). However, the differential diagnosis between malignant and inflammatory masses in the pancreas was not feasible by endoscopic ultrasound, either prospectively (detection rate 69%) or by comparative analyses of echo structure. Endoscopic ultrasound appears to be a valuable aid to the diagnosis or exclusion of pancreatic tumours. When conventional ultrasound and CT give negative or doubtful results it can be used in conjunction with or instead of ERCP to confirm the diagnosis.

Adult↗
PubMed1990

[Colon endosonography. Initial experiences in clinical use].

For the first time we report about a new diagnostic technique, the endoluminal ultrasound of the colon. It enables us to examine the whole colon by an ultrasound endoscope. The ultrasound frequency of the instrument (XCF-UM2, Olympus Optical/Aloka, Japan) is 7.5 MHz, the roundview is approximately 320 degrees. The mean advantage is the combination of endoscopic inspection including biopsy and endoluminal ultrasound. First clinical experience was gained at a total of 27 examinations. It was possible to demonstrate the normal colonic wall (n = 10) in the entire large bowel, neighbouring organs could be visualized clearly and reproducibly in most cases. Pathologic findings (four carcinomas, eight polyps, five anastomoses) were correctly diagnosed by endosonography with a sensitivity of 100% and a specificity of 96%. In two cases the histopathologic work-up of the resected specimens confirmed the ultrasonographic diagnosis of malignancy, while the endoscopic biopsy indicated benign wall lesions. This suggests that endosonography may be superior to histological diagnosis by biopsy in some cases.

Adult↗
PubMed1990

A new ultrasonic probe for endosonographic imaging of the upper GI-tract. Preliminary observations.

A new ultrasonic probe (7.5 MHz, diameter 3.7 mm) was used in vitro in 3 gastric resection specimens and in vivo in 12 patients in an attempt to visualize normal and pathological wall structure of the esophagus, stomach and duodenum via the working channel of a gastroscope, and of the biliary tract via the percutaneous approach. In 5 of these patients conventional endosonography was performed. The probe visualizes the normal layer structure and pathological lesions of the upper GI-tract wall, since it can be accurately positioned at the structure of interest under visual control; water is instilled into the hollow organs to improve transmission of the ultrasound beam. Intra- and transmural changes such as blood vessels in the wall of the esophagus and stomach in portal hypertension, or gastric and esophageal tumors were demonstrated. The important advantage of the probe is that it can be used in stenosed or narrowed hollow organs, where conventional endosonography fails. However, the depth of penetration of the ultrasonic beam (10-15 mm) and circumferential imaging of the gastric wall are still inferior to those of conventional endoscopic ultrasound. As the focus distance of the ultrasound probe to the biliary ducts is too small, visualization of the biliary system is incomplete. Technical improvements could make this new probe an irreplacable diagnostic tool in the future.

Diagnostic Imaging↗
PubMed1990

A 19-year-old female with blue rubber bleb nevus syndrome. Endoscopic laser photocoagulation and surgical resection of gastrointestinal angiomata.

A case of a blue rubber bleb nevus syndrome in a 19-year-old female patient with multiple cutaneous and gastrointestinal hemangiomata is described. Recurrent GI bleeding resulted in severe chronic anemia, which was successfully treated by endoscopic laser photocoagulation and surgical resection. Both forms of therapy had to be repeated 4 years later, the patient having been well in the meantime. This combined endoscopic and surgical approach might also improve the survival of patients with severe GI hemorrhage due to blue rubber bleb nevus syndrome.

Adult↗
PubMed1990

Frequency-dependent secretion of pancreatic amylase, lipase, trypsin, and chymotrypsin during vagal stimulation in rats.

Pancreatic enzyme secretion in rats has been shown to be stimulated differentially by the intestinal hormones secretin and cholecystokinin. Since it is unknown if activation of neural mechanisms have similar effects, it was the aim of the present study to examine in anesthetized rats the output of the pancreatic enzymes amylase, lipase, trypsin, and chymotrypsin before (15 min), during, and after (30 min each) vagal stimulation (5 ms, 10 V) with different frequencies (0.5, 5, 10, and 50 Hz). At 5 Hz, a maximal stimulation of all four enzymes was observed, with a peak towards the end of the vagal stimulation period. At 0.5 Hz, amylase, trypsin, and chymotrypsin were released not only in smaller quantities but also in a different time pattern (trypsin and chymotrypsin), with a maximum early during vagal stimulation. Lipase secretion remained unchanged at 0.5 Hz. At 10 Hz, the output of amylase, lipase, and trypsin was quantitatively less compared to 5 Hz. In contrast to stimulation at 0.5 and 5 Hz, the maximal enzyme output was reached after cessation of vagal stimulation (amylase and lipase). Chymotrypsin release did not change in response to vagal stimulation at 10 Hz. A frequency of 50 Hz had no influence on the secretion of any of the four enzymes determined. These data demonstrate that activation of the vagus nerves can lead to a differential release of pancreatic enzymes. The exact regulatory mechanisms of action are as yet unknown and remain to be determined.

Amylases↗
PubMed1990

[Time factors in endoscopic studies. A survey in West Germany].

In order to obtain representative data for the orientation of personal requirements in endoscopic units, 650 hospitals in the FRG were asked to have an exact look at the times they needed for endoscopic procedures during an period of 14 days. 25% of the contacted hospitals answered to this request and thus the times required for more than 14,000 endoscopic procedures for both, doctors and medical staff, could be analysed. Results revealed that most of the sophisticated procedures such as colonoscopy, ERCP (especially when they included therapeutic endoscopical methods) varied largely in time. This was caused by different factors such as the patient dependent variables, and the course of the procedure including observation of safety and hygiene standards. Average values of times needed for endoscopic procedures were as follows (time in minutes): (Table: see text). The data given above might be of value for the estimation of actual personal and time requirements in endoscopic units.

Endoscopy↗
PubMed1989

Effects of CCK-8 in combination with natural or synthetic secretin on amylase, lipase, trypsin, and chymotrypsin secretion in rats.

In the present study, we examined the interaction between CCK-8 and natural or synthetic secretin on pancreatic enzyme secretion. On anaesthetized rats, a proximal duodenal segment was continuously perfused with saline and amylase, lipase, trypsin, and chymotrypsin were determined in the perfusate. Neither during iv saline nor during iv secretin (natural or synthetic) at doses of 0.01, 0.05, or 0.1 CU/kg/h, any of the four enzymes changed significantly from basal values over a period of 100 min. Iv CCK-8 at stepwise increasing doses of 5, 10, and 20 pmol/kg/h elicited a significant increase of all four enzymes at the medium dose, with a further increase of amylase and trypsin, but not lipase and chymotrypsin at 20 pmol/kg/h. The addition of secretin at all 3 doses potentiated CCK-induced trypsin output. The effects of natural secretin were more pronounced than those of the synthetic peptide. Secretin significantly increased amylase secretion over basal at the lowest dose of CCK-8 (5 pmol/kg/h) that by itself had no effect on amylase release. Only the higher doses of natural but not synthetic secretin augmented lipase secretion during the lowest dose of CCK-8. Both forms of secretin had no further stimulatory effect on CCK-induced chymotrypsin secretion. The present data demonstrate that, first, in rats a potentiation of CCK-8-induced enzyme secretion by low doses of secretin is different for the four enzymes, which suggests a differential regulatory action of these two intestinal hormones on pancreatic enzyme release. Second, the different effects of natural secretin may represent those of contaminants suggesting that only synthetic secretin should be employed in future studies of this peptide on pancreatic enzyme secretion.

Amylases↗
PubMed1988

Preoperative staging of a distal common bile duct tumor by endoscopic ultrasound.

A 27-yr-old man with a long-standing history of primary sclerosing cholangitis presented with recurrent episodes of fever and progressive weight loss over 6 mo. The diagnosis of a distal cholangiocarcinoma was made by endoscopic retrograde cholangiography and transpapillary biopsy. The extent of the tumor could be reliably assessed by endoscopic ultrasound, whereas computed tomography scan, angiography, and transabdominal ultrasound failed to visualize the tumor. The intraoperative findings and histologic work-up of the resected specimen confirmed a T3N0M0 adenocarcinoma of the distal common bile duct.

Adenocarcinoma↗
PubMed1988

[Primary sclerosing cholangitis].

Primary sclerosing cholangitis (PSC) is a chronic fibrous-obliterative inflammation of bile ducts of unknown origin. Genetic, infectious and immunological mechanisms are believed to be involved in the pathogenesis. The clinical signs and symptoms in the early stages are non-specific, laboratory evaluation shows a marked elevation of alkaline phosphatase and a lower rise of transaminases. The diagnosis is confirmed by endoscopic retrograde cholangiography. Histologic findings are non-specific. About 60% of patients with PSC have chronic inflammatory bowel disease, mainly ulcerative colitis. The risk of developing carcinoma of the bile ducts is also increased in patients with PSC. Therapy with glucocorticoids, colchicin, immunosuppressive agents, cholestyramin and penicillamin generally is unsatisfactory. In advanced stages liver transplantation should be performed.

Bile Ducts↗
PubMed1987

Fractional cleansing of the large bowel with "Golytely" for colonoscopic preparation: a controlled trial.

"Golytely", a lavage solution for colonoscopic preparation, has been in clinical use since 1980. Patients usually drink all the fluid (4-61 "Golytely") the morning before colonoscopy. However, clinical observation shows that many, especially elderly, patients have difficulty tolerating these large volumes. We therefore compared two methods of drinking "Golytely" in 36 patients: One group of 18 patients underwent a two-stage lavage preparation (in the evening and the following morning before the examination), the other group drank all the fluid in the early morning before colonoscopy. Patients tolerated the two-stage method significantly better-in terms of nausea (p less than 0.05) and their willingness to repeat the procedure (p less than 0.001). In both groups the bowel was equally clean and the amount of fluid required for preparation did not differ. We conclude that this new method of drinking "Golytely" is far more convenient for the patient and does not reduce the effectiveness of bowel preparation.

Adult↗
PubMedDate not supplied

Endoscopic ultrasonography in the evaluation of colon and rectal disease.

Endosonography of the colon has until recently been limited to examination of the rectum. Rigid and flexible instruments are currently available which allow for detailed images of the rectal wall. Comparative studies suggest that endosonography may be more accurate than computed tomography in the preoperative staging of rectal carcinoma. Recently, an ultrasound colonoscope has been developed which allows for visual examination, biopsy, and endosonography throughout the colon. Experience with this technique is limited and its role in the evaluation of colonic disease has not yet been determined. Further comparative trials are needed to more fully define the role of endosonography in the diagnosis of colorectal disease.

Colon↗