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U Weickert

Publications and source records attributed to U Weickert.

At least 19 recordsLinked to original sources
PubMed2006

[Patient acceptance of magnetic resonance colonography: a prospective inquiry for comparison to conventional colonoscopy].

BACKGROUND AND OBJECTIVE: Precondition for establishment of magnetic resonance colonography (MRCG) as a diagnostic tool in secondary prevention of colorectal cancer is not only high diagnostic accuracy but also a good acceptance amongst patients. The aim of this study was to compare post-examination appraisal of patients for MRCG to that of bowel preparation and conventional colonoscopy. PATIENTS AND METHODS: 88 patients (24 women, 64 men, mean age 67 +- 17,3 years) were interviewed by a standardized questionnaire regarding pain/discomfort (scale from 1 to 10), overall assessment of difficulties and preference for future tests. After bowel cleansing, MRCG and conventional colonoscopy were performed on the same day. Bowel cleansing consisted of drinking about 5 liters of a polyethylene glycol-electrolyte solution. For MRCG the colon was filled with ca. 2000 ml of tap water. Imaging was performed with a 1.5T MR scanner in the prone position. RESULTS: Most unpleasant for the patients was the preceding bowel preparation (70%), followed by colonoscopy (14%) and MRCG (8%). The preferred method was MRCG (58%) followed by colonoscopy (20,5%). The most unpleasant symptoms named by patients were the amount of oral electrolyte solution that had to be drunk (34%), abdominal pressure (25%), nausea (24%) because of bowel preparation, body positioning (25%) and rectal tube (13%) during MRCG, abdominal pressure (19%) and pain (18%) during colonoscopy. CONCLUSION: Patients' acceptance of MRCG indicates that it has a potential role as an additional diagnostic tool in secondary prevention of colorectal cancer.

Aged↗
PubMed2006

[The management of bleeding ulcers].

Bleeding peptic ulcers are responsible for about half of all upper gastrointestinal hemorrhages, one of the most frequent gastroenterological emergencies. In its pathogenesis, infection with Helicobacter pylori and the use of ulcerogenic drugs play a dominant role. Endoscopy has to be performed urgently when a decline in hemoglobin and/or hemodynamic instability occurs. The indications for local endoscopic therapy depend on the Forrest criteria, which include bleeding and the presence or absence of a blood clot or visible vessel. Local endoscopic therapy comprises injections and mechanical or thermal procedures. The efficacy of these procedures has been demonstrated. Additionally, proton pump inhibitors are administered. The prognosis for bleeding ulcers depends on the endoscopic findings as well as the age and comorbidity of the patients.

Endoscopy, Gastrointestinal↗
PubMed2006

[Space-occupying lesion of the pancreas--how frequently not due to a suspected ductal adenocarcinoma?].

In patients with a space-occupying lesion of the pancreas at first a primary ductal adenocarcinoma is considered as the cause. Other tumours or metastases are assumed to occur very rarely. Therapy and prognosis of other pancreas tumours differ from therapy and prognosis of a primary ductal adenocarcinoma. We therefore examined the question of how frequently a space-occupying lesion of the pancreas was not due to a ductal adenocarcinoma in our case materials. Retrospectively 70 patients who had undergone a percutaneous puncture of a space-occupying mass of the pancreas under ultrasonographic control were included in the study (34 women, 36 men). In 62 patients a clear histological diagnosis was possible on the basis of the biopsy. In 53 cases (76 %) a primary adenocarcinoma of the pancreas could be diagnosed. In 5 patients (7 %) these masses turned out to be metastases of a previously known malignant tumour disease (2 x mammary carcinoma, 2 x gastric carcinoma, 1 x sigmoid carcinoma). Other tumours could be detected in 4 cases (6 %) including a tuberculoma, an endocrine tumour, a fusocellular sarcoma with partial neurogenic differentiation and a large-cell and pleomorphic-cell anaplastic, partly sarcomatoid carcinoma. In patients with a space-occupying lesion of the pancreas, tumours other than a ductal adenocarcinoma are not rare. In particular, in cases of a previously known malignant tumour disease a space-occupying lesion of the pancreas can also turn out to be a metastasis. Every other individual tumour entity is rare. Other tumour entities at large, however, are found in daily routine. The preoperative biopsy of space-occupying lesions of the pancreas, therefore, still has a clinical importance for the further therapy planning.

Aged↗
PubMed2006

Long-Segment early squamous cell carcinoma of the proximal esophagus: curative treatment and long-term follow-up after 5-aminolevulinic acid (5-ALA)-photodynamic therapy.

Photodynamic therapy (PDT) is an established treatment for the ablation of dysplastic Barrett's epithelium and early esophageal carcinoma, but no data have been published on curative 5-aminolevulinic acid (5-ALA)-PDT for long-segment early esophageal cancer with infiltration of the upper sphincter. We describe successful curative treatment of an unusual early long-segment squamous cell carcinoma (uT1a,N0) of the proximal esophagus (18 - 28 cm aborally), with three sessions of 5-ALA-PDT. Endoscopic and endosonographic follow-up macroscopically showed a complete remission of the tumor, proven by biopsy showing total histological ablation. After a follow-up period of 23 months, there has been no indication of tumor recurrence. Early superficial (< 3 mm) squamous cell carcinomas of the esophagus can be ablated completely by 5-ALA-PDT. However, long-term follow-up is required in order to prove the effectiveness of endoscopic ablation therapy for early esophageal cancer.

Aminolevulinic Acid↗
PubMed2006

Frequency of small bowel polyps in patients with duodenal adenoma but without familial adenomatous polyposis.

INTRODUCTION: It is uncertain whether patients with duodenal adenomas without familial adenomatous polyposis (FAP) are at greater risk for small bowel neoplasia. We therefore conducted a study to determine the frequency of small bowel polyps in patients with non-papillary duodenal adenomas using capsule endoscopy for small bowel examination. PATIENTS AND METHODS: 14 patients (8 women, 6 men; mean age 67 +/- 10 years; range: 49 - 77 years) with non-papillary duodenal adenomas without FAP were included. All patients underwent wireless capsule endoscopy. The results were compared with an age- and sex-matched cohort of patients undergoing capsule endoscopy for suspected small bowel disease. RESULTS: Overall, 15 polyps ranging between 1 and 8 mm in diameter were detected in eight patients of the study group, whereas no polyps could be identified in the control group. Natural excretion of the capsule within 24 hours was always reported and no complications were reported by any of the patients. Other pathological findings were multiple angiodysplasias in two patients of the study group. In the control group capsule endoscopy detected angiodysplasias in 5 patients with the indication obscure gastrointestinal bleeding, and inflammatory lesions in 2 patients with suspected Crohn's disease. CONCLUSIONS: Based on the results of this prospective study, the frequency of small bowel polyps in patients with duodenal adenomas without familial adenomatous polyposis appears to be increased compared with a control group undergoing capsule endoscopy for other reasons. In none of the patients was the management altered. Follow-up data of these patients will be needed.

Adenoma↗
PubMed2005

[Gastrointestinal tumor (GIST) of the esophagus in a 34-year-old man: clubbed fingers and alopecia arealis as an early paraneoplastic phenomenon].

HISTORY: A 34-year-old previously healthy man presented to his general practitioner with nocturnal sweating, feeling full and a weight loss of 6 kg in three months. Over a period of one year clubbing of the fingers had developed and alopecia areata had been noted six months before the diagnosis was established. INVESTIGATIONS AND DIAGNOSIS: Out-patient sonography revealed two large, partly cystic-necrotic space-occupying lesions in the liver. Sonographically guided fine-needle puncture showed cells of a mesenchymal tumor with great cell density and extensive necroses. Gastroscopy and endosonography demonstrated, as a possible primary tumor, a submucosal space-occupying lesion, ca. 3 x 5 cm, in the distal esophagus. Immunochemical tests revealed a leiomyosarcoma. TREATMENT AND COURSE: A gastrectomy and resection of the distal esophagus were performed, together with a liver wedge resection. Histopathological examination of the surgical specimen confirmed the diagnosis of leiomyosarcoma. Further immunochemical tests provided the diagnostic criteria of a gastrointestinal stroma tumor (GIST). The patient died one year after operation from hepatic and peritoneal metastases. CONCLUSION: Tumors of the gastrointestinal tract may for a long time produce no or, as in this case, only nonspecific symptoms. An early diagnosis is, however, possible if little known early paraneoplastic phenomena are noted in the clinical examination.

Adult↗
PubMed2005

[Complications of diagnostic laparoscopy].

BACKGROUND AND OBJECTIVE: The frequency of diagnostic laparoscopy performed by internists has increased for several years once again -- especially performed as minilaparoscopy. A determination of the value of diagnostic laparoscopy is possible only with knowledge of the complication rate. PATIENTS AND METHODS: We reviewed a consecutive series of 675 laparoscopies (422male, 253 female, age 15 - 85 ) from 1996 to 2003 in our clinic. Possible risk factors for complications were analyzed. RESULTS: Minor complications occurred in 35/675 (5,2 %) laparoscopies, major complications in 8/675 (1,1 %) laparoscopies. There was no significant difference between conventional and minilaparoscopies. The existence of Child C cirrhosis was the only significiant risk factor identified for the occurrence of a major complication. CONCLUSION: Both conventional and minilaparoscopy have an acceptable rate of complications. When Child C cirrhosis is present, laparoscopy should be restricted to very few patients, as the complication rate is elevated in this condition.

Adolescent↗
PubMed2005

[Rare cause of cholestatic hepatitis].

When bile duct obstruction is ruled out newly developed icterus is mainly caused by infection with hepatotropic viruses, autoimmune hepatitis or drug induced hepatopathy. We report on a 30 year old previously healthy patient with cholestatic hepatitis which was caused by infection with Treponema pallidum. Cholestatic hepatitis resolved after administration of penicillin without recurrence.

Adult↗
PubMed2005

Does Cytokeratin7/20 immunoreactivity help to distinguish Barrett's esophagus from gastric intestinal metaplasia? Results of a prospective study of 75 patients.

Barrett's esophagus is a recognized risk factor for the development of esophageal dysplasia and carcinoma. Unfortunately, gastric incomplete intestinal metaplasia arising in Short Segment Barrett's esophagus can be indistinguishable histologically on hematoxylin/eosin stains. Distinct patterns of CK 7 and CK 20 immunohistochemical expression have been demonstrated to be both highly sensitive and specific for Barrett's esophagus, but have not been found in gastric metaplasia. The aim of our study was to test whether immunostaining with CK 7/20 helps to distinguish between Barrett's epithelium and gastric incomplete metaplasia. Cases of long segment Barrett's esophagus, short segment Barrett's esophagus, and cases with a normal gastroesophageal junction, as well as specimens with gastric antral intestninal metaplasia, were examined: three patterns were defined. Barrett's pattern (superficial CK 20 staining; superficial and crypt CK 7 staining); gastric pattern (superficial and crypt staining of both markers); other patterns (different from Barrett and gastric types). Seventy-five patients were enrolled in this study, 26 with long segment Barrett's esophagus, 21 with short segment esophagus, 13 with intestinal metaplasia of the cardia, and 18 with antral intestinal metaplasia. The Barrett pattern showed a high specificity of 97%, but a sensitivity of only 30% in patients with short segment Barrett esophagus. Our results do not confirm the hypothesis that CK 7/20 immunostaining can be used for a reliable differentiation between incomplete intestinal metaplasia and Barrett's epithelium.

Adult↗
PubMed2005

[Interventional endoscopy for benign and malignant bile duct strictures].

During the past years several endoscopic and interventional techniques have been developed for the treatment of bile duct strictures and have had a strong impact on therapeutic regimens. Benign stenoses of the bile duct are mainly caused by cholecystectomy or liver resection or by inflammatory diseases. Insertion of an endoprosthesis insertion or balloon dilation is clinically successful in 60 to 90 % of these patients and will result in adequate opening of the stricture. To date, only bile duct stenosis in chronic pancreatitis are not improved satisfactorily by endoscopy. The insertion of an endoprosthesis is a cornerstone in the treatment of malignant obstructive jaundice in patients with cancer. Several comparative studies have demonstrated the advantages of self-expanding metal stents (SEMS) over plastic prostheses in terms of patency. A selective use of SEMS is mandatory, as the costs for SEMS are high and many patients with malignant jaundice will die with their first plastic prosthesis in situ without stent occlusion. In patients with hilar cholangiocarcinoma, the combination of photodynamic therapy and endoprosthesis insertion might result in a survival advantage. The use of bioabsorbable stent materials or coating of the stent with antiproliferative drugs will improve the treatment results in the future.

Bile Duct Neoplasms↗
PubMed2005

[The diagnosis of liver cirrhosis: a comparative evaluation of standard laparoscopy, mini-laparoscopy and histology].

BACKGROUND: The superiority of laparoscopy with guided biopsy over biopsy alone is established. It is still uncertain if this is also true for midi-/ and mini-laparoscopy. AIM: The aim of this study was to determine the diagnostic gain of laparoscopic-guided biopsy for standard laparoscopy and the use of midi-/mini-laparoscopies. Characteristics of the liver biopsies were investigated with regard to a missed diagnosis of cirrhosis. METHODS: In a consecutive series of 425 patients clinical, laparoscopic and histological findings were investigated. The length and fragmentation of the liver biopsies were investigated with regard to a missed diagnosis of cirrhosis. RESULTS: The sensitivity of laparoscopy in the diagnosis of cirrhosis was 96 %, that of histology 68 %. The sensitivity of histology alone was especially low in macronodular cirrhosis. The sensitivity of both laparoscopy and histology improved from Child A to C. When cirrhosis was apparent, liver biopsies were shorter and more frequently fragmented. However, the diagnosis of cirrhosis was independent of these parameters. CONCLUSION: Mini-laparoscopy may replace standard laparoscopy and appears to be superior compared with histology alone.

Adolescent↗
PubMed2005

Diagnostic laparoscopy.

Each diagnostic procedure needs to be viewed in the context of all the other available diagnostic tools, and therefore has to be reevaluated periodically. This is also true of diagnostic laparoscopy, whether performed by gastroenterologists in patients under sedoanalgesia or by surgeons in patients under general anesthesia. Publications during the previous year have shed light on many important issues. Despite its greater expense, fluorescence laparoscopy may have advantages over white-light laparoscopy in the diagnosis of small tumor seeding. The unchanged superiority of laparoscopy over other imaging modalities for detecting small superficial liver metastases and peritoneal seeding has been clearly demonstrated. Whether cytological investigation of peritoneal washing can add relevant information to laparoscopy remains a matter of debate. Diagnostic laparoscopy before surgery has proved to be effective in many fields, including traumatology. The use of diagnostic laparoscopy in certain clinical circumstances, such as the early postoperative period after major cardiac surgery using extracorporeal circulation, appears promising. A transgastric approach to the peritoneal cavity for diagnostic and therapeutic purposes, the feasibility of which has been demonstrated in a porcine model, is an exciting innovation with as yet unforeseeable implications.

Abdominal Pain↗
PubMed2005

[Comparison of 3 types of covered self-expanding metal stents for the palliation of malignant dysphagia: results from the prospective Ludwigshafen Esophageal Cancer Register].

BACKGROUND: Endoscopic stenting with self-expanding metal stents (SEMS) has proved to be an efficient palliative endoscopic therapy option in treating malignant dysphagia. Different types of SEMS have been examined previously in small randomized clinical trials. METHODS: A total of 150 consecutive patients (from 1/1995-1/2004; 35 females, 115 males) with a median age of 66 years (range 43-94 years) were evaluated. Three different types of SEMS were examined: Group A: Gianturco Z Stent n = 59 pts.; Gruppe B: Ultraflex Stent n = 49 pts.; Gruppe C: Flamingo Wallstent n = 42 pts.). Dysphagia was categorized into grade 0 (no dysphagia) to grade 4 (total obstruction). RESULTS: Stent insertion was successfully evaluated in 55/59 (93 %) of the patients in group A, in 47/49 (96 %) of the patients in group B and in 40/42 (95 %) of the patients in group C (p = 0.78). After stent insertion, a reduction in the dysphagia score from 2.77 to 0.99 was observed in group A, from 2.58 to 0.72 in group B and from 2.62 to 0.81 in group C (p = 0.37). The median time to dysphagia recurrence was 78 days in group A, 90 days in group B and 70 days in group C (p = 0.45). The median overall survival time was 96 days in group A, 118 days in group B and 108 days in group C (p = 0.18). The incidence of high grade complications was 34 % in group A, 16 % in group B and 17 % in group C (p = 0.04). CONCLUSIONS: The 3 types of SEMS examined in this study showed similar efficacies in treating malignant dysphagia. However, the major complication rate of the Gianturco Z stent was significantly higher when compared to the complication rate of the Ultraflex stent and the Flamingo Wallstent.

Adenocarcinoma↗
PubMed2005

Long-term outcome of percutaneous transhepatic drainage for benign bile duct stenoses.

PURPOSE: The occurrence of benign bile duct stenoses is mostly associated with prior biliary surgery, pancreatic diseases or sclerosing cholangitis. It remains a challenging problem for gastroenterologists and surgeons, especially in case the endoscopic approach is not possible. The exact role of percutaneous transhepatic stenting for these patients has not been clearly defined yet. MATERIAL AND METHODS: 36 patients with symptomatic benign bile duct stenoses or strictures after surgery underwent percutaneous transhepatic stenting and were studied prospectively. We were particularly interested in how many patients would achieve resolution of the stricture and tolerate removal of the drainage in the long-run. RESULTS: The primary success rate of percutaneous transhepatic biliary drainage (PTBD) was 92% (33/36 patients). All patients presented improvement of jaundice and cholestasis. Relief of the stricture and clinical improvement was achieved in 72% (26/36) of patients after a median stenting time of 14.5 (6-34) months. 5.5% (2/36) required further stenting due to a persistent stricture. A clinical recovery without radiological stricture regression after stenting demonstrated 22% (8/36) of patients. Long-term failures were noted in 27% (10/36) of patients after a median follow-up of 48 months. CONCLUSIONS: Percutaneous transhepatic stenting of symptomatic benign biliary strictures is safe and highly effective in achieving adequate internal bile drainage. There seems to be a therapeutic benefit not only for short-term interventional treatment but also as a sufficient long-term therapeutic alternative to surgery with tolerable complication rates.

Adult↗
PubMed2005

Patient acceptance of diagnostic laparoscopy.

PURPOSE: To assess patient acceptance of diagnostic conventional laparoscopy and minilaparoscopy under sedoanalgesia. MATERIALS AND METHODS: 120 consecutive patients undergoing diagnostic laparoscopy were enrolled prospectively in this study. Within the first week after diagnostic laparoscopy the patients were asked to answer a total of eight questions with regard to the acceptance of the procedure. RESULTS: The inconvenience of laparoscopy was assessed with a mean of 1.6 on a scale from 0 to 10 (0 = no inconvenience, 10 = very unpleasant). The discomfort in the two days following laparoscopy were graded with a mean of 2.1 on a scale from 0 to 10 (0 = no inconvenience, 10 = very unpleasant). There was no difference between conventional laparoscopy and minilaparoscopy. Only 10% of the patients described laparoscopy more inconvenient in comparison to diagnostic gastroscopy, whereas 29% of the patients assessed diagnostic gastroscopy more inconvenient. CONCLUSIONS: Diagnostic laparoscopy under sedoanalgesia is a very well tolerated procedure. There is no difference between conventional laparoscopy and minilaparoscopy.

Abdominal Pain↗