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Biomedical subjects

U Scheurer

Publications and source records attributed to U Scheurer.

At least 19 recordsLinked to original sources
PubMed1996

Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival.

OBJECTIVES: In prospective trials in patients with malignant biliary obstruction, it has been reported that Wallstents prolong stent patency, but this does not translate into a significant survival benefit. Compared with prospective trials, however, survival may be different in clinical practice because of differences in patient compliance. We report on a retrospective, long term analysis comparing Wallstents versus plastic stents. METHODS: Plastic endoprostheses (70 patients) and endoscopic Wallstents (95 patients) were placed in 165 consecutive patients with irresectable, malignant biliary obstruction in a first (1990-91) and second (1992-93) time period. Stent occlusion was treated by plastic stent placement. RESULTS: Patient characteristics were quite comparable in both stent groups. Initial placement of a Wallstent resulted in an increase of median stent patency of the first (10 vs 4 months, p < 0.001) and second (8 vs 3 months, p < 0.05) stent, a decrease of additional endoscopic procedures (20 vs 58%, p < 0.005), an increase of patient compliance reflected by a decrease of patients dying with untreated stent occlusion (9 vs 30%, p < 0.001), and an increase of survival time (6.5 vs 4 months, p < 0.05). CONCLUSIONS: Initial placement of a Wallstent results in an increase of stent patency of the first and second stent. Duration of stent patency appears to have a determinant effect on patient compliance. Increased stent patency and patient compliance seem to improve survival in clinical practice.

Aged↗
PubMed1996

[Pancreatic carcinoma: diagnosis].

Early detection, tumor diagnosis with histological proof and tumor-staging are the principle aims of diagnostic approaches in patients suffering from pancreatic cancer. Asymptomatic and small cancers are often missed since they produce no or no typical symptoms and no reliable screening methods are available. Symptomatic pancreatic cancers are often so advanced that only about 20-30% of patients qualify for curative treatment. The diagnosis of pancreatic cancer with histological characterization occurs by imaging techniques [sonography and CT-scan with guided fine needle punction, MRI, ERCP with biopsy or aspiration cytology, endoscopic sonography] and in some cases by laparoscopy or laparotomy. The combined use of tumor markers [CA 19-9, CEA, elastase-1] support the diagnosis of pancreatic cancer. The same methods used for diagnosis are also used for the preoperative tumor staging. Unfortunately the accuracy of these methods is smaller than 77%. The involvement of lymph nodes, encasement of large vessels and small liver metastases or a peritoneal spread of the tumor may be difficult to visualize and the real extent of the disease may only be observed during laparotomy.

Adult↗
PubMed1995

[Clinical manifestations of cholelithiasis and its complications].

Gallbladder stones remain asymptomatic over a long period. The biliary colic is the typical pain caused by these stones. Dyspeptic symptoms seem to be unrelated to the presence of gallstones. Acute cholecystitis, a serious complication of gallstone disease, spans a wide spectrum of clinical findings. The typical signs are right upper abdominal pain and tenderness, fever, leucocytosis and Murphy's sign. 35% of patients experience gallbladder empyema or perforation. Localized gallbladder perforation, characterized by high fever, severe right upper abdominal pain and tenderness and a palpable mass is often difficult to distinguish from acute cholecystitis. Free perforation into the abdominal cavity causes diffuse peritonitis. Gallbladder perforation into the lumen of an adjacent organ produces fistulas, mostly with minimal symptoms or a pain relief after decompression of the inflamed gallbladder. Air in the bile ducts and on some occasions bile-acid-induced diarrhea may result. Rarely, the perforation of large stones leads to an occlusion of the GI tract and results in a gallstone ileus. Common bile duct stones may be asymptomatic or cause bile duct obstruction with biliary colics and jaundice. Acute bacterial cholangitis characterized by Charcot's triad (pain, jaundice and fever) and the acute biliary pancreatitis with its typical symptoms are the serious complications of common bile duct stones, associated with a high mortality rate. The clinical manifestations of a gallstone disease and its complications reveal important diagnostic features, but the most important diagnostic features, modalities are the imaging procedures. They are decisive for an accurate therapy.

Cholangitis↗
PubMed1994

Substance P activates rat colonic motility via excitatory and inhibitory neural pathways and direct action on muscles.

We studied effects of nicotinic, muscarinic, serotoninergic, dopaminergic, adrenergic, vasoactive intestinal peptide (VIP) antagonists, VIP, nitric oxide-synthase inhibitors and stimulators alone and in combination with tetrodotoxin on substance P (SP)-stimulated intraluminal tone of the isolated proximal, middle and distal rat colon. Tetrodotoxin significantly enhanced SP-stimulated intraluminal tonic pressure in the distal, but not in the middle and proximal colon. N omega-nitro-L-arginine methylester enhanced SP stimulation in all colonic segments, whereas L-arginine inhibited it partially and D-arginine did not affect it. Atropine and hexamethonium partially inhibited SP stimulation of the middle and distal colon. Tetrodotoxin completely abolished the effects of L-arginine, atropine and/or hexamethonium on SP stimulation. Propranolol, phentolamine, reserpine, telenzepine, naloxone, Mr 2266, a VIP antagonist (H9935) and ketanserin did not affect SP-induced colonic muscle stimulation. VIP strongly reduced SP-stimulated intraluminal pressure in all colonic segments. VIP(10-28), a putative VIP antagonist, produced similar inhibition of SP-stimulated intraluminal tonic pressure, but did not affect N omega-nitro-L-arginine methylester-induced enhancement of SP-stimulated intraluminal pressure in any segments. It is concluded that in the isolated rat colon SP-stimulated intraluminal pressure (mainly generated by circular muscles) by a direct action on colonic muscles over the whole colonic length and by simultaneous activation of neural cholinergic excitatory pathways in the middle and distal, of noncholinergic excitatory pathways in the proximal colonic segment, and by activation of nitric oxide-dependent inhibitory neural pathways. VIP seems not to be directly involved in this inhibitory pathway.

Animals↗
PubMed1993

[12 years of endoscopic stone removal].

All 583 attempts at endoscopic clearance of biliary calculi, performed in the Gastrointestinal Unit, Inselspital Bern, were retrospectively analyzed from 1980 until 1991. The average age of the patients was 70; 56% were female and 44% male. In 1980, 26 ERCPs for bile duct stone removal were performed, whereas in 1991 the number had increased to 90. The substantial increase in 1991 occurred after introduction of laparoscopic cholecystectomy. Over the total period of 12 years all stones were removed endoscopically after papillotomy in 82%, while the success rate in 1991 was 90%. Morbidity was 5.4% and lethality 0.2%. Total morbidity did not change markedly. However, the number of severe complications requiring surgical repair was reduced from 1.7% between 1980 and 1986 to 0% between 1987 and 1991. These results suggest that endoscopic removal of bile duct stones is increasingly performed with high success and low complication rates.

Aged↗
PubMed1993

[Hematemesis. Extramural emergency].

Hematemesis is the cardinal sign of upper gastrointestinal bleeding. It is a sign related to numerous affections, with a prognosis depending on the underlying lesion, the degree of bleeding, the accompanying disease and other risk factors. Mortality rates are generally close to 10%, although if hematemesis is secondary to variceal bleeding, as high as 30%. 65% of hemorrhages subside spontaneously, but 25% bleed recurrently (after initial cessation) and in 10% bleeding persists. Three quarters of all renewed bleeding occurs within two days after the initial hemorrhage. If hematemesis occurs outside a hospital, rapid evaluation is required to assess the necessity of emergency transport and treatment. In the case of severe to moderate bleeding, life-support measures and rapid transport to the nearest hospital are of primary importance and all measures complicating diagnosis and treatment in the hospital should be avoided. Patients with mild hematemesis, stable cardiovascular parameters and no risk factors can be investigated and, if appropriate, treated, on an out-patient basis. If the cause of hematemesis cannot be found, aggressive, inpatient investigations are required at the first sign of second bleed. Endoscopy is the primary investigative procedure for hematemesis. The success rate is highest if endoscopy is performed within the first 36 hours of the onset of bleeding. There are indications that aggressive diagnosis and therapy, including endoscopic hemostatic interventions, can reduce hematemesis mortality.

Adult↗
PubMed1993

Effects of ranitidine and cisapride on acid reflux and oesophageal motility in patients with reflux oesophagitis: a 24 hour ambulatory combined pH and manometry study.

The effect of ranitidine and cisapride on acid reflux and oesophageal motility was investigated in 18 patients with endoscopically verified erosive reflux oesophagitis. Each patient was treated with placebo, ranitidine (150 mg twice daily), and ranitidine (150 mg twice daily) plus cisapride (20 mg twice daily) in a double blind, double dummy, within subject, three way cross over design. Oesophageal acidity and motility were monitored under ambulatory conditions for 24 hours on the fourth day of treatment, after a wash out period of 10 days during which patients received only antacids for relief of symptoms. Acid reflux was monitored by a pH electrode located 5 cm above the lower oesophageal sphincter. Intraoesophageal pressure was simultaneously recorded from four transducers placed 20, 15, 10, and 5 cm above the lower oesophageal sphincter. Upright reflux was three times higher than supine reflux (median (range) 13.3 (3.7-35.0)% v 3.7 (0-37.6)% of the time with pH < 4.0, p < 0.01, n = 18). Compared with placebo, ranitidine decreased total reflux (from 10.0 (3.2-32.6)% to 6.4 (1.2-22.9)%, p < 0.01), upright reflux (p < 0.05), supine reflux (p < 0.001), and postprandial reflux (p < 0.01), but did not affect oesophageal motility. The combination of ranitidine with cisapride further diminished the acid reflux found with ranitidine--that is, cisapride led to an additional reduction of total reflux (from 6.4 (1.2-22.9)% to 3.7 (1.0-12.7)%, p < 0.01), supine reflux (p < 0.05), and postprandial reflux (p < 0.05). Cisapride also reduced both the number (p<0.01) and duration (p<0.05) of reflux episodes and significantly increased amplitude, duration, and propagation velocity of oesophageal contractions (p<0.05) but did not affect the number of contractions. The findings show that the 30% reduction of oesophageal acid exposure achieved by a conventional dose of ranitidine (150 mg twice daily) can be improved to more than 60% by combination with cisapride (20 mg twice daily). The cisapride induced increase in oesophageal contractile force and propagation velocity seems to enhance the clearance of gastro-oesophageal reflux. Combination of a histamine H2 receptor antagonist with a prokinetic agent may therefore provide an alternative treatment for reflux oesophagitis.

Adult↗
PubMed1992

Is a fluoroscopic verification of the electrode position necessary in ambulatory intragastric pH monitoring?

To assess whether a fluoroscopic verification of the electrode position is necessary before and whether electrode displacement occurs during intragastric pH measurements, a crossover study was performed in 20 healthy male volunteers. The pH electrode was initially placed in the gastric corpus using pH readings and catheter length only, and the electrode tip was fluoroscopically located before and after the 24-hour study. Only in one study arm was an adjustment of the electrode position allowed, if fluoroscopy showed a position outside the gastric body. Thirty-seven (92%) of all 40 electrodes were in the corpus when placed by pH-metric methods alone. With fluoroscopic guidance, 2 of the 3 electrodes lying outside the corpus could be repositioned as desired. The median night, day or 24-hour gastric pHs measured in the groups with or without replacement of the electrode tip were identical. Displacement after 24-hour measurements did not occur with initially correctly positioned electrodes. Fluoroscopy is not necessary for the verification of the position of electrodes placed by pH-metric techniques in individuals with residual acid secretion, and electrode displacement is rare.

Adult↗
PubMed1991

[Dysphagia].

Dysphagia is a symptom of numerous disorders which should always alert the physician and induce further examinations as soon as possible. For clinical purposes, a subdivision of dysphagia according to the region of interest in oropharyngeal and esophageal types and according to its causes in mechanical and motor types, facilitates the choice of the diagnostic procedure. A subtle history and precise physical examination in most cases allow a correct diagnosis. Endoscopy with sampling material for histology, cytology, bacteriology, mycology and virology, fine needle punction, endosonography, radiologic examinations, such as video-barium-swallow, CT/NMR, longterm pH-manometry and pharmaco-manometry may be needed to confirm the diagnosis and to plan the accurate treatment.

Algorithms↗
PubMed1990

[Indications for endoscopic papillotomy].

Endoscopic sphincterotomy (ES) with stone removal is indicated in the post-cholecystectomy patient with retained or recurrent stones and for the very high risk surgical patient. ES has a role in the treatment of severe acute biliary pancreatitis (ABP), but not in mild ABP. Acute suppurative cholangitis refractory to antibiotics can be successfully treated by ES with stone removal or nasobiliary drainage not only in high risk surgical patients. However, concomitant occurrence of abscesses in the liver and other locations, and of gallbladder empyema, calls for an interdisciplinary approach (surgical, endoscopic and radiological). Controlled studies in this field are needed. The role of ES and stone removal in cholelithiasis of patients with gallbladders in situ and low surgical risk remains controversial, as does the treatment of patients with sump syndrome after choledochoduodenostomy, with biliary-cutaneous or biliary-enteric fistulas and benign strictures, which must be evaluated by accurate comparative studies. Whereas ES has its place in the treatment of Oddi sphincter dysfunction with elevated sphincter pressures, and for the introduction of large bore endoprostheses for palliative treatment of malignant biliary stenoses, ES is still experimental in the treatment of pancreatolithiasis, pancreatic duct stenoses, endoscopic gallbladder stone removal and transpapillary retrograde cholangioscopy.

Cholangitis↗
PubMed1990

Different motor actions of dynorphins and nonpeptide kappa opioid receptor agonists in the isolated rat colon.

Dynorphin 1-17 has been suggested to be the endogenous ligand for kappa opioid receptors. In this study motor effects of dynorphin 1-17, its N-terminal fragments d-Pen2,d-Pen5-enkephalin (DPDPE) and d-Ser2-[Leu5]enkephalin-Thr (DSLET) without or with pretreatment with naloxone, (-)-2-(furylmethyl)-noretacocine (Mr 2266) or tetrodotoxin (TTX) on the isolated rat colon were compared with those of nonpeptide kappa opioid receptor agonists. Intraluminal pressure changes were measured by perfusion manometry in preparations maintained in a standard organ bath. Dynorphin 1-17, 1-9, 1-8, 1-6, [Leu5]enkephalin, DPDPE and DSLET dose dependently stimulated the tone in the proximal, middle and distal colon with the maximum response at 10(-6) to 10(-5) M. The stimulation produced by Tyr-Gly-Gly-Phe and Tyr-Gly-Gly was 60 and 600 times less potent, respectively. Concentrations of 10(-10) to 10(-6) M des-Tyr1-[Leu5]enkephalin, dynorphin 3-13, 6-17, 1-methyl-2-(3-thienylcarbonyl)-amino-ethyl-5-(2-fluorophenyl)-H-2,3 dihydro-1,4-benzodiazepine, trans-(+/-)-3,4-dichloro-N-methyl-N-(2-(1-pyrrolidinyl) cyclohexyl)-benzene- acetamide-methane sulfonate and (5a,7a,8B)-(-)-N-methyl-(7-(1-pyrrolidinyl)-1-oxaspiro(4,5)-dec-8- yl) benzeneacet-amide produced no changes in motor activity of the rat colon. Only doses exceeding 10(-6) M of the latter three substances stimulated colonic tone. This action was inhibited neither by naloxone nor by Mr 2266. In contrast, the stimulation by dynorphin 1-17 and 1-6 was inhibited to a greater extent by naloxone than by Mr 2266.(ABSTRACT TRUNCATED AT 250 WORDS)

3,4-Dichloro-N-methyl-N-(2-(1-pyrrolidinyl)-cycloh↗
PubMed1988

[Endoscopic stone extraction from the biliary tract--current status].

Endoscopic removal of bile duct stones has become a routine procedure. The present situation is analyzed in the light of patients treated in 1985 and 1986 by the same team. We report on 114 patients (46 men, 68 women, median age 74 years). Clearance of bile ducts was possible at first attempt in 80 patients (70%) and at second attempt in a further 8 patients (7%). Procedure-related mortality was 0.9%: one patient died after developing necrotizing pancreatitis. The complication rate was 10.6%. Among the 39 patients with gallbladders left in situ, 4 (10.8%) had to undergo cholecystectomy after an interval of 1 to 7 months. It is concluded that endoscopic removal of bile duct stones is a method with a high rate of success. However, even in experienced hands complications are by no means negligible.

Adult↗
PubMed1987

Verrucous acanthosis--so-called verrucous carcinoma--of the esophagus.

Verrucous carcinoma of the esophagus is a rare variant of squamous cell carcinoma with a slow, non-invasive growth without formation of metastases. Until today, only 8 cases of verrucous carcinoma of the esophagus have been reported in the literature. All of these tumours showed infiltration of adjacent mediastinal structures or even lymph node metastases. In therefore seems doubtful, wether these tumours were really verrucous carcinomas rather than squamous cell carcinomas of the papillary type. Several authors have questioned the malignant nature of these tumors recently. We report a case of a verrucous lesion of the esophagus the course of which we were able to observe over a period of several years. Transhiatal esophagectomy without thoracotomy is recommended as treatment of choice for verrucous tumours of the esophagus.

Carcinoma, Papillary↗