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T Wehrmann

Publications and source records attributed to T Wehrmann.

At least 19 recordsLinked to original sources
PubMed2006

Quality of psychomotor recovery after propofol sedation for routine endoscopy: a randomized and controlled study.

BACKGROUND AND STUDY AIMS: Propofol sedation is increasingly being used for endoscopy in the outpatient setting. In view of the agent's short period of action, current recommendations that patients should avoid driving or using public transport unescorted for 24 h may be too strict. Psychomotor recovery and driving skills before and after sedation were therefore assessed. PATIENTS AND METHODS: A total of 100 patients undergoing routine upper or lower gastrointestinal endoscopy were randomly sedated either with propofol alone or with midazolam plus pethidine. The recovery time and quality of recovery were assessed. Psychomotor recovery was evaluated using the number connection test (NCT) and a driving simulator test 1 h before and 2 h after the endoscopic procedure. RESULTS: Ninety-six patients completed the 2-hour post-sedation procedure. Vital signs were recorded, and no clinically relevant complications occurred. The mean recovery time and quality of recovery were significantly better after propofol sedation (14 +/- 9 min vs. 25 +/- 8 min and 8.7 +/- 1.3 vs. 6.3 +/- 1.1 points) ( P < 0.01). Psychomotor and driving skills after propofol sedation were similar to the baseline results, while in the midazolam/pethidine group, patients showed significantly more lane deviations (1.1 +/- 0.9 vs. 1.6 +/- 0.9), time over the speed limit (0.3 +/- 0.83 vs. 0.6 +/- 0.88), missed stoplights more often (0.05 +/- 0.31 vs. 0.11 +/- 0.35), and had slower reaction times for unexpected events (1.11 +/- 0.46 s vs. 1.39 +/- 0.44 s) ( P < 0.01). The time needed to complete the NCT after sedation did not differ between the two groups (32.1 +/- 12.0 s vs. 33.4 +/- 12.6 s for propofol; 31.5 +/- 11.2 s vs. 34.6 +/- 12.8 s for midazolam/pethidine). CONCLUSIONS: Current recommendations that patients should refrain from driving and unescorted use of public transport for 24 h after sedation may need to be reconsidered in patients who receive propofol sedation.

Analgesics, Opioid↗
PubMed2006

Intraductal ultrasonography in the diagnosis of Mirizzi syndrome.

BACKGROUND AND STUDY AIMS: Common bile duct (CBD) compression can be caused by stones in the cystic duct (Mirizzi syndrome) which can be difficult to diagnose even with endoscopic retrograde cholangiopancreatography (ERCP). Conventional imaging often gives insufficient information and endoscopic ultrasonography (EUS) and magnetic resonance imaging may improve diagnostic accuracy, but often the final diagnosis is made during exploratory surgery. PATIENTS AND METHODS: All patients undergoing ERCP during a 3-year period were prospectively analyzed if they fulfilled the inclusion criteria: gallbladder in situ; obstructive jaundice with CBD stenosis, demonstrated at endoscopic retrograde cholangiography (ERC), but unexplained at ultrasonography; and inability to demonstrate the cystic duct during ERC. Intraductal ultrasonography (IDUS) was carried out over a guide wire using a 20-MHz probe. Prior to ERCP, patients were evaluated with abdominal ultrasonography and computed tomography (CT), as well as by magnetic resonance cholangiopancreatography (MRCP) or EUS in some. RESULTS: 74 patients out of 2089 undergoing ERCP fulfilled the entry criteria. Final diagnoses, from surgical exploration (n = 41), cytology (n = 21), or endoscopic extraction of stones from the cystic duct (n = 12), were Mirizzi syndrome (type I) in 30 patients and other causes in 44 patients (gallbladder carcinoma [n = 16], pancreatic carcinoma [n = 9], metastatic compression [n = 9], other [n = 10]). CT had shown suspected Mirizzi syndrome in 1/30 cases (3 %) and MRCP in 12/19 evaluated cases (63 %). EUS allowed a correct diagnosis in 11 of 15 evaluated cases (73 %). IDUS required an additional 8 +/- 3 min and showed a sensitivity of 97 % and specificity of 100 %. CONCLUSION: IDUS is a sensitive and specific method for the diagnosis of Mirizzi syndrome.

Aged↗
PubMed2005

Reduction of miss rates of colonic adenomas by zoom chromoendoscopy.

BACKGROUND AND AIMS: The aim of this study was to determine the detection rate of polyps using zoom chromoendoscopy (ZE) compared with standard video colonoscopy. PATIENTS AND METHODS: End-to-end colonoscopies were performed in 50 patients by two different endoscopists blinded for each other's results. Lesions detected during initial standard colonoscopy (C1) were biopsied or removed by snare resection. The second colonoscopy (C2) was done with a zoom colonoscope spraying the whole colon with indigocarmine (0.4%). In addition, detected mucosal lesions were documented prior to ZE and then classified according to the pit pattern classification before biopsy or removal. The retrieval time for each procedure was determined. RESULTS: The average retrieval time for C1 was 13+/-9 min (9-24) and 28+/-11 min (16-38, p<0.05) for ZE. During C1, 56 lesions were detected in 26 of 50 patients (34 hyperplastic and 22 adenomatous). During C2, 19 additional polyps were documented prior to ZE (15% tandem miss rate), and 20 further lesions were detected with ZE (21% additional polyp detection rate compared to C1 and C2 without ZE). Of the 39 additional lesions removed during C2 after ZE, 29 were hyperplastic and 10 were adenomatous. Most adenomas detected during the second investigation were found in patients in whom adenomatous polyps had already been removed during the initial colonoscopy (9 of 26 patients vs 1 of 24 patients, p<0.02). No carcinoma was detected. The pit pattern classification allowed a correct differentiation between hyperplastic and adenomatous polyps (accuracy 93%, sensitivity 90%, specificity 97%). CONCLUSION: Using zoom chromoendoscopy, the rate of detecting colonic polyps can be increased at the cost of a longer retrieval time.

Adenoma↗
PubMed2004

Endoscopic resection of submucosal esophageal tumors: a prospective case series.

BACKGROUND AND STUDY AIM: The introduction of endoscopic ultrasound (EUS) and endoscopic mucosal resection has offered a new alternative to simple observation or surgical resection for the management of esophageal submucosal tumors. PATIENTS AND METHODS: During a 4-year period, endoscopic resection was attempted in 20 consecutive patients (nine women, 11 men; mean age 52 +/- 10 years) with esophageal submucosal tumors < 4 cm in size, confirmed by endoscopy and miniprobe EUS (20 MHz). The mean tumor diameter was 17 +/- 8 mm (8 - 34 mm). Prior EUS-guided cytological examination revealed benign tumors in 11 patients; however, endoscopic resection was attempted in most patients for diagnostic purposes also. Several patients were symptomatic (retrosternal pain, n = 4; dysphagia, n = 4; recurrent bleeding, n = 2) but most tumors had been detected incidentally. RESULTS: In the majority of patients the tumor was ligated with a rubber band and then resected with a snare (n = 11), and in the others simple snare resection ("lift-and-cut," n = 7) or cap resection (n = 2) was done. A macroscopically complete endoscopic resection was achieved in 19/20 patients, and the remaining patient was managed surgically. Endoscopic hemostasis was necessary (and successful) in eight patients (40 %), but blood transfusion was not required. No other side effects occurred. Histological examination revealed granular cell tumor in 12 patients, leiomyoma in six patients, and a lipoma and stromal tumor in one patient each. Histologically, all tumors were judged to be benign and a microscopically complete resection (R0) was achieved in all patients, with the exception of the one patient with a stromal tumor. Thus, surgical resection was necessary in only two of the 20 patients (10 %). During the median prospective follow-up of 12 months no tumor recurrence was detected in any patient. CONCLUSION: Endoscopic resection of esophageal submucosal tumors is safe and effective. The probability of achieving curative resection (R0 resection, histologically benign) is high especially if the tumors are smaller in size (< 4 cm).

Endoscopy↗
PubMed2003

Staging of colonic neoplasms by colonoscopic miniprobe ultrasonography.

BACKGROUND AND AIMS: In contrast to the situation in the upper gastrointestinal tract staging of colonic neoplasm by endoscopic ultrasonography (EUS) has not gained importance because until yet preoperative staging is without any clinical consequences. This may change with the introduction of minimally invasive surgical procedures and endoscopic resection techniques as an alternative to conventional (open) surgery. PATIENTS AND METHODS: We performed EUS with a miniprobe in 54 consecutive patients with colonic tumors who had been referred to our hospital for endoscopic resection or for laparoscopic resection of their lesions. Therefore patients with locally advanced tumors or systemic tumor spread were not included. After detection of the lesion during colonoscopy miniprobe EUS was performed with water-filling of the colonic lumen. The depth of invasion (T classification) and the local lymph node status (positive or negative) was ascertained. Lymph node-negative lesions staged as T1 underwent endoscopic resection whenever this was technically possible. In lymph node-negative T2-3 tumors laparoscopic resection was planned if they were localized at least 10 cm apart from the flexuras. All other lesions were resected by open surgery. The EUS findings were later compared with the final pathological results (pTN classification) of the resected specimen. RESULTS: In 50 patients (93%) a sufficient EUS evaluation of the colonic tumor was possible. In one patient with a tumor at the left flexura the lesion could not be completely visualized, and in three patients a sufficient water filling of the colon was impossible. The infiltration depth was correctly classified in 17 adenomas, 16 T1, 8 T2, 5 T3, and one T4-carcinoma (EUS accuracy for T staging: 94%). Two T2 and one T3 carcinoma were overstaged by EUS while no understaging was recorded. The lymph node status was correctly classified in 42/50 patients (84%), and a false-negative lymph node status was found in only 4/50 cases (8%). The overall accuracy of EUS was 80%. CONCLUSION: Miniprobe EUS is suitable and has a sufficient but not optimal accuracy for staging of colonic neoplasm. Its employment makes sense if minimally invasive resection techniques in patients with high-risk for open surgery are planned.

Adenoma↗
PubMed2003

[Clinical value of intraductal ultrasonography for clarification of confusing ERCP results].

OBJECTIVE: This study assesses the value of intraductal ultrasound (IDUS) when the findings of endoscopic retrograde cholangio-pancreatography (ERCP) are unclear. PATIENTS AND METHODS: IDUS was performed over a two-year period in cases of bile duct or pancreatic duct stenosis of unknown origin found during ERCP or if cholelithiasis was suspected but ERC was seemingly normal. Duct stenoses were classified,before and after IDUS, as benign or malignant ductal or malignant extraductal, the findings then being checked by clinical follow-up,histology or, if bile duct stones had been suspected, by instrumental bile duct exploration. RESULTS: Among 1303 ERCP investigations IDUS was attempted in 125 patients (9.6%; average age 60+/-14 years; 62 females). IDUS failed in seven patients for technical reasons (failure rate 6%). IDUS took an average time of 9+/-3 min. ERCP plus IDUS provided correct classification in 52 of 60 patients with bile duct stenosis (87%), and in 14 of 16 (88%) patients with pancreatic duct stenosis.ERCP alone correctly classified duct stenosis in 54 of 76 patients(87%), but in 66 of 76 (87%) with additional IDUS. The correct demonstration or exclusion of choledocholithiasis was obtained by IDUS in 40 of 42 patients (95%). Thus IDUS changed the diagnosis made by ERCP in 28 of 118 patients (24%). CONCLUSION: With minor expenditure of time and an acceptable failure rate, additional IDUS after ERCP increases the diagnostic accuracy in cases where ductal stenosis or bile duct stones have not been clearly demonstrated.

Adenocarcinoma↗
PubMed2003

Reduced risk for pancreatitis after endoscopic microtransducer manometry of the sphincter of Oddi: a randomized comparison with the perfusion manometry technique.

BACKGROUND AND STUDY AIMS: Endoscopic microtransducer manometry of the sphincter of Oddi has been shown to be a reliable alternative to perfusion manometry for evaluating sphincter of Oddi motor function. It avoids volume loading of the biliopancreatic system, and may therefore be associated with a lower risk of inducing postmanometry pancreatitis.[nl] PATIENTS AND METHODS: During a 2-year period, microtransducer manometry of the sphincter of Oddi was carried out in 215 patients (median age 42 years; 155 women; biliary study in 152 cases, additional pancreatic evaluation in 63 cases). Sphincter of Oddi manometry was conducted as the sole procedure in all patients. The frequency of pancreatitis was assessed prospectively and graded according to established guidelines. A total of 130 consecutive patients (median age 37 years, 92 women; 30 with biliary type II, 58 with type III, 34 with pancreatic type I, and eight with type II) were then randomly assigned to undergo microtransducer or perfusion manometry of the sphincter of Oddi in a standardized fashion. RESULTS: During the initial 2-year period, nine cases of pancreatitis (a pancreatitis frequency of 4.2 %) were observed after microtransducer manometry, and most were of mild degree (six mild, two moderate, and one severe). No deaths occurred, and no surgical procedures were required. In the randomized part of the study, the demographic and clinical characteristics of the patients in both groups, as well as the technical aspects of the procedures performed, were well matched. The frequency of pancreatitis after microtransducer manometry was 3.1 %, compared with 13.8 % after perfusion manometry ( P < 0.05). Pancreatitis occurred in two patients after microtransducer manometry, and was mild in both cases. After perfusion manometry, mild pancreatitis occurred in six patients and moderate pancreatitis in three. CONCLUSION: Endoscopic microtransducer manometry of the sphincter of Oddi is associated with a lower risk for postmanometry pancreatitis than standard perfusion manometry.

Adult↗
PubMed2002

Endoscopic snare resection of large colonic polyps: how far can we go?

BACKGROUND AND AIMS: Colonoscopic polypectomy is preventing colorectal cancer. Videoendoscopy and new perendoscopic hemostasis techniques make endoscopic polypectomy of large colonic polyps an alternative to the surgical approach. This study examined whether complete snare resection of giant colonic polyps is feasible and safe and for determining how often surgery is necessary due to invasive cancer detected histologically after polypectomy. PATIENTS AND METHODS: The study included 59 consecutive patients with 68 colonic polyps larger 30 mm in diameter. Snare polypectomy was performed after an endoscopic ultrasound with a miniprobe found no sign of invasive, or, depending on the appearance of the polyp, a bleeding prophylaxis had been carried out. Acute procedural or delayed bleeding was treated endoscopically. RESULTS: Of the 68 polyps 26, mostly pedunculated were resected en bloc (38%) and histologically ensured as completely resected; 42 polyps had to be resected by piecemeal technique (62%). Piecemeal resection was performed significantly more often in sessile polyps (38/41, 93%) than in pedunculated polyps (4/27, 15%, P<0.01). Follow-up colonoscopy after 3 months showed remaining adenomatous tissue of piecemeal-resected polyps in 12 cases (28%), which were 12 resected sessile polyps (29%) and no case of resected pedunculated polyp. To achieve complete resection of sessile polyps a second procedure was necessary significantly more often than for resection of pedunculated polyps (12 cases in sessile polyps, 18% vs. no case in pedunculated polyps). Remaining adenomatous tissue was removed in all 12 cases during the first follow-up colonoscopy after 3 months, confirmed by a biopsy 6 months after the initial procedure. Overall coexisting malignancy was found in only 7 polyps (12%). Due to high-risk factors only one of them underwent secondary surgical procedure. CONCLUSION: The present study shows that endoscopic snare resection of giant colonic polyps is a safe procedure, and that secondary operative measures for managing coexisting malignancy are rarely necessary.

Adenomatous Polyps↗
PubMed2001

Topical application of nitrates onto the papilla of Vater: manometric and clinical results.

BACKGROUND AND STUDY AIMS: Systemic administration of nitrates inhibits motility of the sphincter of Oddi (SO) but is hampered by a decrease of the arterial blood pressure. We evaluate whether topical application of glyceril trinitrate (GTN) onto the papilla can facilitate cannulation of the common bile duct during routine endoscopic retrograde cholangiopancreatography (ERCP) and compare the effect of topical GTN with that of isosorbide dinitrate (ISDN) on SO motility. PATIENTS AND METHODS: A total of 80 patients undergoing routine ERCP for suspected biliary obstruction received topical application of either saline (n = 40) or 10 mg of GTN (n = 40) onto the papilla of Vater in a randomized, double-blind fashion. Thereafter, selective bile-duct cannulation was attempted with a 0.035" hydrophilic guide wire. In another trial, 16 biliary type III patients underwent endoscopic SO-manometry and received in a randomized fashion either 10 mg of GTN (n = 8) or 10 mg of ISDN (n = 8) which was infused topically onto the papilla via the manometric catheter. Thereafter, the manometric recording was continued for a further 5 minutes. RESULTS: A spontaneous opening of the papilla with concurrent transpapillary bile flow was observed in 24/40 patients after topical GTN, and in only 8/40 patients after topical saline (P < 0.01). However, neither the number of cannulation attempts nor the time until successful cannulation differed significantly between the groups. In addition, the pre-cut rate was nearly identical in the two groups. Topical GTN showed no significant influence on the mean arterial blood pressure. The SO-baseline pressure was significantly lowered by topical GTN (28.2+/-12.9 mm Hg before ISDN vs. 22.5+/-13.7 mmHg after P<0.01). The phasic SO motility was also strongly inhibited by both drugs. However, the effect of GTN completely wanes after 3 minutes, whereas ISDN inhibited SO motility for > 5 minutes in all patients. CONCLUSIONS: Both topically administered GTN and ISDN evoked a profound inhibition of SO motility, but the effect of ISDN was longer lasting than that of GTN. However, locally administered GTN did not facilitate selective bile-duct access during routine ERCP.

Administration, Topical↗
PubMed2001

Correlation between sphincter of Oddi manometry and intraductal ultrasound morphology in patients with suspected sphincter of Oddi dysfunction.

BACKGROUND AND STUDY AIMS: Intraductal ultrasonography (IDUS) makes it possible to study sphincter of Oddi morphology during endoscopy. Two recent IDUS studies have described the sphincter of Oddi as a circumferential hypoechoic layer in the papilla, but there have as yet been few published data from patients with suspected sphincter of Oddi pathology. PATIENTS AND METHODS: Twenty-one consecutive patients with suspected biliary sphincter of Oddi dysfunction (seven men, 14 women; age 54 +/- 17 years) were enrolled in the study. Endoscopic sphincter of Oddi manometry was carried out using a 4-Fr electronic microtransducer device. After this, a wire-guided 6-Fr ultrasound catheter was placed in the common bile duct (CBD), and IDUS was carried out while the ultrasound catheter was being withdrawn from the CBD toward the duodenum. RESULTS: Sphincter of Oddi manometry and IDUS were carried out successfully in 18 of the 21 patients. Sphincter of Oddi manometry revealed sphincter of Oddi hypertension (baseline pressure > 35 mmHg) in eight patients. The mean sphincter of Oddi baseline pressure was 32 +/- 17 mmHg, and the mean phasic sphincter of Oddi pressure was 132 +/- 31 mmHg. During IDUS, a circumferential hypoechoic layer was clearly delineated in all patients. There was a significant correlation between the manometrically determined length of the sphincter of Oddi (8 +/- 2 mm) and the thickness of the hypoechoic layer (6 +/- 2 mm) as assessed by IDUS (r = 0.66, P < 0.001). However, no correlation was found between the baseline or phasic sphincter of Oddi pressures and the thickness of the hypoechoic layer. Accordingly, IDUS did not allow identification of patients with sphincter of Oddi hypertension. Mild pancreatitis was observed in one of the 18 patients (6 %). CONCLUSIONS: The circumferential hypoechoic layer of the papilla visualized by IDUS is the ultrasonographic correlate of the sphincter of Oddi. IDUS of the papilla is technically feasible and safe in patients with suspected sphincter of Oddi dysfunction. IDUS may provide additional information at the sphincter of Oddi level, but cannot be used as a substitute for sphincter of Oddi manometry.

Adult↗
PubMed2001

[Endoscopic mucosal resection of premalignant lesions of the upper gastrointestinal tract].

BACKGROUND: Surgical therapy of early malignancies of the upper gastrointestinal tract is associated with substantial morbidity and mortality, especially in elderly and co-morbid patients. In Japan endoscopic mucosal resection (EMR) has been proven to be safe and efficacious in this indication. PATIENTS AND METHODS: 22 patients (68 +/- 14 years, 9 females) with high-grade dysplasia of the esophagus (n = 5), early carcinoma of the esophagus (T1N0M0, n = 11) or early gastric cancer (T1N0M0, n = 6) proven by high-resolution videoendoscopy (plus chromoendoscopy in most cases), miniprobe-endosonography (12-20 MHz) and biopsy were enrolled. The lesion size ranged from 7-40 mm in diameter. EMR was performed using a monofile snare, in almost all cases after submucosal injection of an attenuated epinephrine-solution (1:20,000) to effect a lifting sign. "En bloc" resection was possible in 17/22 cases (77 %), but in 5 patients piecemeal-resection had to be performed due to a larger lesion size. RESULTS: Active bleeding occurred on 14 of 22 occasions (64 %), in another 5 patients secondary bleeding (within 24 h after EMR) were detected. All these events could be managed endoscopically (mainly by hemoclip application) and blood transfusion was not required. Other complications did not occur. A complete resection (R0) was achieved in 21/22 cases, however, one patient had to undergo a second EMR procedure because histology of the first resected specimen had revealed malignant infiltration of the resection margin (R1). After the second EMR procedure complete (R0)-resection was obtained. Compared to the histological findings after EMR the pre-procedural staging proved to be correct in all cases. The control examinations (clinical exam, lab data, endoscopy with multiple biopsies, endosonography and CT) after EMR revealed no local or systemic cancer recurrence in 21/22 patients (median follow-up 5 months, range 3-12 months). However, in one patient with adenocarcinoma and Barrett-esophagus another mucosal adenocarcinoma was detected 3 months after EMR (located in opposite to the initial carcinoma treated with EMR). CONCLUSION: EMR seems to be a safe and effective (regarding local tumor control) therapy for high-grade dyplasia and early malignancies in the upper gastrointestinal tract. However, long-term follow-up in these patients has to be awaited.

Adenocarcinoma↗
PubMed2001

Transmural drainage of cystic peripancreatic lesions with a new large-channel echo endoscope.

BACKGROUND AND STUDY AIMS: The availability of a new large-channel echo endoscope led us to develop a new needle-stent device for endoscopic puncture and drainage of pancreatogenic cystic lesions. The purpose of this study was to examine whether endoscopic ultrasound (EUS)-guided one-step 10-F puncture and drainage with the new equipment could be feasible and successful. The use of the technique and the short-term outcome in our first four patients are described and discussed. PATIENTS AND METHODS: Cystic lesions were drained using the new technique in four patients. All the patients had symptomatic peripancreatic lesions, one with intrahepatic and one with intrasplenic extension. Punctures were carried out using a new echo endoscope with a 3.7 mm working channel and an Albarran lever. The 10-F transmural stents were placed over a 1 mm stainless steel needle and a 6-F Teflon catheter using a special assembly designed for controlled one-step placement and stent release. RESULTS: Puncture and drainage were technically successful in two patients. In one patient, the 10-F component failed to pass the cystic wall. Drainage was successful in the same session using a 7-F one-step device. In one patient, no stent was placed, but the 1 mm needle was used for diagnostic tissue sampling during the procedure because of the suspicious cyst morphology. Surgical resection revealed a ganglioneuroma. CONCLUSIONS: The new echo endoscope allows endoscopic interventions for peripancreatic cystic lesions under excellent endoscopic and EUS control. The Albarran lever was reliable and helpful for optimal direction of the needle. The new echo endoscope combined with special needle-stent devices was effective and safe for diagnosis and therapy in the first four cystic lesions. Cystic tumors must always be considered as a differential diagnosis in patients with apparently pancreatitis-induced cystic lesions.

Adult↗
PubMed2000

Retroperitoneal endoscopic debridement for infected peripancreatic necrosis.

Standard management of infected peripancreatic necrosis consists of open surgical debridement and lavage--a traumatic intervention with substantial morbidity and mortality. As an alternative and novel approach with minimum invasiveness, we present fenestration of the gastric wall and debridement of infected necrosis by direct retroperitoneal endoscopy. In three patients, this strategy led to rapid clinical improvement and no serious complications. Transgastric endoscopic therapy may be a less traumatic alternative to surgery and should be further assessed in prospective studies.

Acute Disease↗
PubMed2000

[Ultrasound diagnosis of penicillin-induced segmental hemorrhagic colitis].

INTRODUCTION: Penicillin-induced segmental haemorrhagic colitis (SHC) is a characteristic and striking but rarely diagnosed clinical entity. Bloody diarrhea and abdominal cramps start a few days after the intake of oral penicillin derivatives. We report the ultrasonographic and clinical findings in nine patients with SHC and compare the results with the findings in ten patients with antibiotic-related pseudomembranous colitis (PMC). METHODS: Nine consecutive patients with SHC (age: 32 +/- 10 years; five males, four females) with PMC-negative proctoscopic findings, stool cultures and negative clostridium difficile toxin and ten patients with PMC (age: 50 +/- 18 years; six males, four females) with positive proctoscopy and Clostridium difficile toxin were clinically evaluated and examined by high resolution ultrasonography. The sonographic findings of the colonic and small bowel walls as well as the clinical course of the diseases were documented. RESULTS: In all nine patients with SHC the wall of the ascending colon was asymmetrically thickened with loss of layer structure. Neither the small bowel nor the cecum were involved in patients with SHC. In all cases a distinct border between involved and uninvolved colon wall was found. During follow-up all patients recovered soon after stopping antibiotic treatment and symptomatic care. In seven of ten patients with PMC pancolitis and in three of ten with left-sided colitis were found at ultrasonography. In all patients with PMC the bowel wall was symmetrically thickened with the layers remaining distinct. DISCUSSION: The knowledge of the clinical characteristics and sonographic findings of penicillin-induced segmental haemorrhagic colitis may reduce the need for invasive endoscopic and radiological investigations in diagnosis and follow-up. The age of patients, clinical course and sonographic findings may be helpful in differentiating patients with SHC and PMC.

Adolescent↗
PubMed2000

Sedation with propofol plus midazolam versus propofol alone for interventional endoscopic procedures: a prospective, randomized study.

AIM: Adequate patient sedation is mandatory for most interventional endoscopic procedures. Recent anaesthesiologic studies indicates that propofol and midazolam act synergistically in combination and therefore may be superior to sedation with propofol alone in terms of sedation efficacy, recovery and costs (due to a presumed lower total dose of propofol needed). METHODS: A total of 239 consecutive patients undergoing therapeutic EGD or ERCP (EGD/ERCP-ratio, 1:1) randomly received either propofol alone (n=120, group A, loading dose 40-60 mg intravenously, followed by repeated doses of 20 mg) or propofol plus midazolam (n=119, group B, initial midazolam dose of 2. 5-3.5 mg intravenously, followed by repeated doses of 20 mg of propofol) for sedation. Vital signs (heart rate, blood pressure, oxygen saturation, electrocardiogram) were continuously monitored. Procedure-related parameters, the recovery time and quality (post-anaesthesia recovery score) as well as the patient's co-operation and tolerance to the procedure (visual analogue scale) were prospectively assessed. RESULTS: Patients of group A and B were well matched with respect to demographic and clinical data, endoscopic findings, and the type of associated procedures. In group A, a mean dose of 0.25 +/- 0.13 mg.min/kg propofol was used compared to 0.20 +/- 0.09 mg.min/kg of propofol in group B (P < 0.01, plus additional 2.9 +/- 0.5 mg of midazolam). Clinically relevant changes in vital signs were observed at comparable frequencies with a lowering of the systolic blood pressure < 90 mmHg in six out of 119 patients in group B and one out of 120 patients in group A (P=0.07). The sedation efficacy was rated similarly in both groups, whereas the mean recovery time (group A, 19 +/- 7 min vs. group B, 25 +/- 8 min, P < 0.05) as well as the recovery score (post-anaesthesia recovery score group A, 8.0 +/- 1.1 vs. post-anaesthesia recovery score group B, 7.3 +/- 1.2, P < 0.001) were significantly better with propofol alone than with propofol plus midazolam. CONCLUSION: During therapeutic endoscopy, sedation with propofol and midazolam requires a lower total dose of propofol, but otherwise has no superior sedation efficacy and is associated with a slower post-procedure recovery than sedation with propofol alone.

Adult↗