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Biomedical subjects

U Seefeld

Publications and source records attributed to U Seefeld.

18 recordsLinked to original sources
PubMed1989

Rubber band ligation for piles can be disastrous in HIV-positive patients.

We report a patient with haemorrhoids treated with rubber band ligation who developed a huge supralevator abscess. A diverting sigmoidostomy had to be established as surgical drainage via the rectum was not adequate. Eventually the patient accepted the HIV-testing which proved positive. Six months later the sigmoidostomy was still needed as the abscess cavity remained large. We conclude that rubber band ligation in HIV-positive patients should be abandoned.

Abscess↗
PubMed1985

[Prospective follow-up study of radically resected colorectal carcinoma. Status after 5 years].

207 patients curatively resected for colorectal cancer have been followed up in a prospective, controlled study using serial CEA, ultrasound, colonoscopy and clinical examination for early detection of recurrent tumor. After a median follow-up of 2.5 years, 52 recurrences (25%) have been detected, rising CEA value being the most sensitive indicator (86%) among the diagnostic procedures. 26 patients were reoperated for recurrent disease; in 10 out of 19 patients with local and 3 out of 7 patients with distant recurrence a potentially curative resection was possible. Median survival of patients not operated upon (n = 26) or incompletely resected (n = 13) is 8.5 months, whereas median survival for the 13 patients reoperated for cure has not yet been reached at 2 1/2 years. With respect to resectability, thorough clinical examination and endoscopy have been the most sensitive examinations (both 44%). Aggressive follow-up for suitable patients with colorectal cancer will detect most of the recurrences in an early asymptomatic phase, increase the rate of resectability and prolong survival in selected, curatively reresected cases.

Carcinoembryonic Antigen↗
PubMed1984

Endoscopic follow-up after colorectal cancer surgery. Early detection of local recurrence?

This study deals with 188 consecutive patients who had a radically resected colorectal carcinoma and who were later controlled by colonoscopy. The median interval between resection and endoscopy was 2.5 (0.5-19) years. In 20 patients, a local recurrence was found (10.6%). In 11 of these 20 patients the indication for colonoscopy was the clinical suspicion of a recurrence. The remaining nine patients were asymptomatic, and colonoscopy was done as a routine procedure. In six of nine asymptomatic patients, a potentially curative resection of the recurrent tumor was possible, which was not possible in any of the 11 symptomatic patients. Nineteen of the 20 patients with a local recurrence could be followed up. Five of the six patients with potentially curative resection of the recurrence were asymptomatic for a median time of 38 (12-72) months after surgery; in contrast, 9 of 13 patients without curative operation died after a median survival period of 8 (1-24) months. The results of this study suggest that good long-term prognosis may be expected in patients in whom local recurrence is detected at an early asymptomatic stage with the possibility of potentially curative resection. Therefore, the authors propose regular endoscopic examinations in the first years after curative colorectal cancer surgery.

Adult↗
PubMed1984

Monoclonal gammopathy in chronic active hepatitis.

Immunoelectrophoresis was performed in 31 of 272 patients with chronic active hepatitis (CAH) because of an M-spike component (seven patients, 2.6%) or hypergammaglobulinemia (24 patients) revealing a monoclonal gammopathy (MG) in 11 patients. In addition, 50 randomly selected patients with CAH and no evidence for an M-spike component were tested by immunoelectrophoresis. In 13 patients (26%), an MG was found. The mean age of the 24 patients with MG was 57.4 years (range: 23-76). HBsAg was present in nine patients (37.5%), no HBV-marker was detected in ten patients (41.7%). The immunoglobulin class of MG was IgG in ten patients (41.7%), IgA in one patient (4.2%) and IgM in 11 patients (45.8%). In two patients, Bence Jones protein was found in either serum or urine. In only one patient was the MG associated with multiple myeloma, whereas none of the other 23 patients developed a malignant lymphoproliferative disease within the median observation period of 6 years. We conclude that there is an unexpectedly high prevalence of benign MG in patients with CAH.

Adolescent↗
PubMed1983

[Endoscopic papillotomy in preserved gallbladder].

Endoscopic papillotomy was attempted in 60 high risk patients (mean age 76 years) with complications of common bile duct stones and preserved gallbladder. Successful papillotomy and bile duct clearance was achieved in 56 patients (93%). One patient died of bleeding shortly after papillotomy. In 5 patients without signs of complication, cholecystectomy was performed prophylactically. Three patients were lost to follow-up. No cholecystectomy was performed in 47 patients (mean follow-up 24 months). 35 (74%) of these cases were free of biliary symptoms; 5 (11%) complained of nonspecific dyspeptic pain and only 2 (4%) had biliary colic. Complications due to the preserved gallbladder occurred in 5 of 47 patients (11%). Two patients had a short transient bout of jaundice and cholangitis respectively. Three patients developed acute cholecystitis with subsequent empyema. Four out of five complications occurred within one month and in three of them the cystic duct was occluded at papillotomy. In summary, treatment of common bile duct stones by endoscopic papillotomy appears to be justified in high risk patients with preserved gallbladder. Gallbladder related complications are mainly to be expected early in the follow-up or in cases with cystic duct occlusion at papillotomy. Because of the risk of empyema, early cholecystectomy is indicated in cases of acute cholecystitis.

Adult↗
PubMed1983

[Findings in the upper gastrointestinal tract in Crohn disease].

The features, frequency and clinical significance of Crohn's lesions in the upper gastrointestinal tract have been investigated. In 11 out of 28 randomly selected patients, lesions which may be caused by Crohn's disease were found on panendoscopy. These were serpiginous ulcerations in the pars II of the duodenum, as well as aphthous-like lesions and polypoid mucosal folds in the esophagus, antrum and duodenum. In 2 cases each of polypoid folds and aphthous-like lesions, the diagnosis was corroborated by histological finding of a granulomatous inflammation. The lesions suspected to be caused by Crohn's disease were found especially in younger patients and were accompanied by upper abdominal symptoms, but showed no correlation with the clinical activity of the disease.

Adolescent↗
PubMed1983

[Endoscopic papillotomy--analysis of complications].

Complications were observed in 19 out of 250 patients undergoing endoscopic papillotomy. In 215 patients in whom papillotomy was successful the frequency of complications was 2.8%, in contrast to 37% in 35 patients with failed therapy (p less than 0.0001). Furthermore, the complications of successful papillotomy were observed immediately, except in one patient with gallstone ileus. The following 19 complications were observed: cholangitis (5), pancreatitis (5), bleeding (5), perforation (2), impaction of the Dormia basket (1), and gallstone ileus (1). Three patients died, all as a result of cholangitis (mortality 1.2%). All patients with pancreatitis had previously had a precutting.

Adult↗
PubMed1983

[Clinical significance of pancreas divisum].

Pancreas divisum was demonstrated in 22 of 500 consecutive ERCP (4.4%). Among patients with otherwise normal ERCP, pancreas divisum was found in 12.8%. In contrast, only 1.8% of patients with other pathology in the ERCP exhibited pancreas divisum (p less than 0.001). In relation to the clinical indication, pancreas divisum was found in 13.3% of patients with suspected or proven pancreatitis, in 1.9% of patients with suspicion of biliary tract disease (p less than 0.001), in 1.9% of patients with suspicion of pancreatic cancer (p less than 0,05) and in 4.4% of patients with epigastric pain of undetermined origin (p greater than 0.05). In 14 patients pancreas divisum was the only pathological finding in a thorough clinical and gastrointestinal workup; 6 of the 14 patients had had typical episodes of pancreatitis, in 6 other patients there was clinical and biochemical evidence of pancreatic disease (mainly pain and hyperenzymemia), and the last 2 cases had chronic epigastric pain without biochemical abnormalities. In 2 patients of this series the pancreas divisum was misinterpreted morphologically (sonography, autopsy) as tumor of the head of the pancreas. Based upon our experience and the literature, the following practical conclusions can be drawn: 1. Pancreas divisum may cause typical episodes of acute (relapsing) pancreatitis. 2. In patients with chronic epigastric pain associated with hyperenzymemia but without typical acute pancreatitis, pancreas divisum may be the cause. 3. Morphologically pancreas divisum may mimic a pancreatic tumor (sonography, computer-tomography, autopsy).

Abdomen↗
PubMed1982

[Endoscopic papillotomy in benign papillary stenosis].

Since 1977 endoscopic sphincterotomy has been indicated in 18 patients because of benign papillary stenosis. In 17 patients cholecystectomy had been performed some time before. The sphincterotomy was successful in 15 patients. In one patient slight bleeding occurred. In 2 of 3 patients in whom sphincterotomy did not succeed, the endoscopic procedure was complicated by cholangitis and pancreatitis respectively. 12 of the 15 patients in whom sphincterotomy was successful were symptom-free over a median period of 21 months. Therefore, endoscopic sphincterotomy appears to be an effective treatment for benign papillary stenosis and is a low-risk procedure compared with surgical sphincterotomy.

Adult↗
PubMed1981

Prevention of hepatitis B virus transmission by the gastrointestinal fibrescope. Successful disinfection with an aldehyde liquid.

In a prospective study we examined the efficacy of a standardized disinfection method in preventing the transmission of hepatitis B virus by the gastrointestinal fibrescope. Four HBSAg- and Dane particle-positive patients who have been endoscoped served as possible sources of hepatitis B virus infection. We cleaned the instrument with a 10% aldehyde liquid and used it immediately thereafter in 10 HBSAg-negative patients. Eight of them were followed-up for 7 months after the endoscopic procedure. None of them showed serological evidence of an endoscopically transmitted hepatitis B virus infection. It is concluded that disinfection with an aldehyde liquid is effective in preventing the transmission of hepatitis B virus by the fibrescope.

Aldehydes↗
PubMed1979

[Salmonella colitis].

Salmonella colitis is defined on the basis of 3 case reports and 75 well-documented cases from the literature. Salmonella colitis is an acute ulcerative colitis occurring in enteric salmonellosis. There is complete clinical and endoscopic remission within 4--8 weeks and no relapse. The disease is to be distinguished from idiopathic ulcerative colitis in a salmonella carrier state. The difficulties of this differential diagnosis are demonstrated in a further case report.

Adult↗
PubMed1979

[Congenital cystic dilatation of the intrahepatic bile ducts. Caroli's disease and its complications].

Two cases with congenital dilatations of the intrahepatic bile ducts are reported. The clinical, diagnostic and therapeutic aspects and possible complications of this rare disease are discussed. The well-known frequent occurrence of cholangiocarcinoma in Caroli's disease is illustrated by one of our patients. Because of the limited therapeutic possibilities, the prognosis of this illness remains unfavourable.

Adult↗
PubMed1977

Esophageal histology in gastroesophageal reflux. Morphometric findings in suction biopsies.

Esophageal suction biopsies were taken in 24 subjects with proven gastroesophageal reflux, 12 subjects with suspected reflux, and 20 healthy controls. Sixty-two percent of the patients with proven reflux, 33% of the patients with suspected reflux, and 10% of the control subjects had neutrophilic and/or eosinophilic granulocytes in the lamina propria. Lymphocytes, plasma cell, and basophilic granulocytes were shown to be constituents of the normal esophageal mucosa. All epithelial dimensions showed marked individual variations in reflux patients and controls. The relative length of stromal papillae as expressed in percent of total epithelial thickness showed a linear correlation with relative basal cell thickness and an indirect linear correlation with epithelial thickness. Elongation of stromal papillae in proven reflux could only be demonstrated by arbitrary retrospective stratification of the data. Hyperplasia of the basal zone and thinning of the epithelium were not observed in the reflux patients. It is concluded that granulocytic infiltrates and not epithelial alterations are the most prominent histological finding in gastroesophageal reflux.

Adult↗
PubMed1976

Gastro-oesophageal reflux disease: correlation of subjective symptoms with 7 objective oesophageal function tests.

Seven tests which have been recommended for the diagnosis of gastro-esophageal reflux were applied in 24 healthy controls and in 48 patients with symptoms of reflux disease. The correlation coefficient of test results with the subjective symptoms of the patient decreased in the following order: 1) acid clearance from the distal esophagus (r = 0.558, p less than 0.001), 2) suction biopsy 5 cm above lower esophageal sphincter (LES) with evaluation of granulocytic infiltrates (r = 0.450, p less 0.001), 3) radiological demonstration of hiatal hernia (r = 0.435, p less than 0.001), 4) reflux provocation test (r = 359, p less than 0.01), 5) modified Bernstein test (r = 0.322, p less than 0.01), 6) acid relux test (r = 0.252, p less than 0.05), 7) resting pressure of LES (r = 0.246, p less than 0.05). Results of the Maudsley Personality Inventory were not correlated with subjective symptoms (r = 0.188, p greater than 0.1). By stepwise multiple regression analysis it was shown that optimal diagnosis of reflux is achieved by combination the following 4 procedures: 1) acid clearance, 2) modified Bernstein test, 3) suction biopsy, and 4) radiology.

Biopsy↗