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Biomedical subjects

U Will

Publications and source records attributed to U Will.

At least 19 recordsLinked to original sources
PubMed2006

Isolated vasculitis of the stomach: a novel or rare disease with a difficult differential diagnosis.

In up to 80 % of patients with vasculitis, signs of the disease are also seen in the gastrointestinal tract. However, no cases of exclusively gastric vasculitis have previously been reported. We report here the case of a 45-year-old woman with upper abdominal discomfort (no arthropathy), with gastroscopic and endoscopic ultrasound (EUS) findings that mimicked scirrhous gastric carcinoma. Gastroscopy revealed giant gastric folds and a suspicious antral ulcer (with histological findings suggesting chronic active pangastritis). EUS showed a concentric, thickened gastric wall (8 mm) with "pseudolamellation" and more than five enlarged lymph nodes in the paragastric region (lesser curvature). On the basis of suspected scirrhous gastric carcinoma, the patient underwent a four-fifths gastric resection of the altered parts of the gastric tissue. The postoperative course was uneventful. Histological examination of the specimen revealed severe obliterative panvasculitis of the stomach. During a 22-month follow-up period, no signs or symptoms of systemic primary or secondary vasculitis were found in the patient's medical history, symptoms, laboratory parameters, or imaging. This case shows for the first time that a specific gastric panvasculitis can occur, either as a preliminary stage of the condition or as a distinct manifestation of vasculitis associated with the stomach alone. Gastric resection appears to be indicated in patients with isolated obliterative gastric vasculitis, since it avoids the side effects of long-term immunosuppressive therapy and provides prognostic information that takes account of the differential diagnosis of scirrhous gastric carcinoma.

Diagnosis, Differential↗
PubMed2005

Successful endoscopic management of iatrogenic mediastinal infection and subsequent esophagomediastinal fistula, following endosonographically guided fine-needle aspiration biopsy.

Complications following endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) biopsy are rare. A 75-year-old man underwent EUS-FNA biopsy of an enlarged mediastinal lymph, which histologic investigation revealed to be a metastasis of a hepatocellular carcinoma. The patient developed the postinterventional complication of suppurative infection within the mediastinum. Under EUS guidance, a pigtail catheter and a soft tube were inserted to respectively drain and rinse the mediastinal lesion for 8 days. The remaining esophagomediastinal fistula was closed by gathering the fistula margins, using band ligations and an Endoloop. The fistula healed with no further complaints or dysphagia. Infection is a possible complication of endoluminal FNA biopsy. An endoscopically guided therapeutic approach can be favored as the initial treatment of choice and as a reasonable alternative that avoids surgical intervention.

Aged↗
PubMed2005

Endoscopic ultrasound-assisted rendezvous maneuver to achieve pancreatic duct drainage in obstructive chronic pancreatitis.

Patients with mechanical obstruction of the pancreatic duct, which can be caused by chronic pancreatitis, suffer from recurrent attacks of pain and inflammation of the pancreas. We report a novel approach using an endoscopic ultrasound- (EUS-) assisted rendezvous technique, which allows drainage of the pancreatic duct in patients in whom primary management by transpapillary drainage during an endoscopic retrograde cholangiopancreatography (ERCP) procedure has failed. Transgastric puncture of the pancreatic duct was performed using a 19-gauge needle under EUS guidance, and a 0.035-inch guide wire was introduced into the duct and advanced through the papilla. This wire was pulled into the duodenum using a side-viewing duodenoscope. A papillotomy was performed using the standard technique and a plastic prosthesis was introduced. The patient tolerated the intervention well and was discharged with no further complaints. EUS-assisted drainage of the pancreatic duct using a rendezvous technique is an elegant and feasible minimally invasive endoscopic treatment for symptomatic patients with chronic pancreatitis, in whom transpapillary introduction of a catheter is not possible.

Adult↗
PubMed2003

[Lysis therapy of thrombosis of the superior mesenteric artery].

INTRODUCTION: For surgeons the acute intestinal ischaemia is still a diagnostic and therapeutic challenge. If clinically suspected, the diagnostic procedures such as duplex sonography and arterial angiography should be carried out immediately. Although the diagnosis is often quickly clear, perioperative mortality rate remains high. We report the acute local thrombolytic therapy as an alternative treatment. CASE REPORT: A 80-year-old male patient was referred to our hospital with a complete occlusion of the superior mesenteric artery. Duplex sonography and the arterial angiogram confirmed the clinical diagnosis. Because the patient was assessed to be at high risk we decided to avoid an operation and local thrombolytic therapy using rt-PA and urokinase was carried out. RESULT: The local thrombolytic therapy was successful and led to a complete restoration of the arterial flow within the superior mesenteric artery. The clinical symptoms subsided and no complications were observed. CONCLUSION: Local thrombolytic therapy appears to be a suitable therapeutic option in patients suffering of mesenteric arterial occlusion. Although the duplex sonography often confirms the diagnosis with high accuracy the angiography remains the diagnostic gold standard.

Aged↗
PubMed2002

Hepatic veno-occlusive disease (VOD) with complete occlusion of liver venules after tandem autologous stem cell transplantation-- successful treatment with high-dose methylprednisolone and defibrotide.

Veno-occlusive disease (VOD) is a life-threatening complication following allogeneic or autologous stem cell transplantation. We report on a patient with a high grade B-cell lymphoma who presented 28 days after the second autologous stem cell transplantation with weight gain, ascites, hyperbilirubinemia, and liver venules occlusion as demonstrated by sonography. Starting with high-dose methylprednisolone treatment followed by defibrotide maintenance therapy the patient showed dramatic complete response of VOD, resulting in a normal sonography of the liver and normalization of laboratory values. The response of the occlusion of nearly all liver venules underlines the value of anti-inflammatory treatment combined with new thrombolytic medication such as defibrotide for the treatment of severe VOD.

Adult↗
PubMed2002

Accuracy of endoscopic ultrasonography in upper gastrointestinal submucosal lesions: a prospective multicenter study.

BACKGROUND: Endoscopic ultrasonography (EUS) is commonly agreed to be the best imaging method for diagnosing and differentiating between submucosal lesions in the gastrointestinal tract. However, most of the current evidence for this derives from retrospective multicenter studies. A prospective multicenter analysis of the performance of EUS in diagnosing submucosal lesions in everyday practice was therefore conducted. METHODS: Over a 2-year period, this study included 150 patients (52% men, mean age 59.8 years) from 23 centers who had a presumptive diagnosis of a submucosal lesion on upper gastrointestinal endoscopy. The patients' symptoms and EUS results were recorded. Endoscopic and endosonographic findings regarding lesion size, layer of origin, and the presumptive diagnosis (benign or malignant) were recorded. The reference methods used were surgery, biopsy, other imaging tests, and a follow-up period of 6 months. RESULTS: Of the 150 patients, 102 had an intramural lesion (84 tumors, 18 other lesions such as cysts, aberrant pancreas, etc.), and 48 had an extraluminal compression--in most cases (n = 35) by normal organs or structures. For differentiating between a submucosal and an extraluminal compression, the sensitivity and specificity of endoscopy were 87% and 29%, whereas those of EUS were 92% and 100%. However, the sensitivity and specificity of EUS for differentiating between malignant and benign submucosal tumors were only 64% and 80%, respectively. CONCLUSIONS: The accuracy of EUS in differentiating between submucosal tumors and extraluminal compressions is substantially superior to that of endoscopy, but EUS is still inadequate for differential diagnosis between benign and malignant submucosal tumors. However, EUS is still the best method of visualizing submucosal lesions precisely. The influence of EUS on the further management in these patients remains to be examined in subsequent studies.

Adolescent↗
PubMed2000

Unusual negative side effects of non-steroidal anti-inflammatory drugs in the proximal colon.

Two cases of uncommon side effects of non-steroidal anti-inflammatory drugs (NSAID) are presented which show that in special cases NSAID lesions can be located predominantly in the proximal colon, that NSAID-caused lesions may present themselves as diaphragm-like strictures and that alterations by NSAID in this part of the bowel may bring enormous problems for the differential diagnosis.

Aged↗
PubMed1999

[Success and complication rates of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography--a prospective study].

The aim of the prospective study was to evaluated the efficacy and the complications of 2,820 ERCP-examinations in 1,717 consecutive patients (performed over a three-year period). The rate of success was 82.8% for diagnostic ERCP, 96.6% for endoscopic sphincterotomy, 76.8% for the extraction of stones on common bile tract, 87.5% for drainage in bile tract obstruction, respectively. The rate of all complications amounted to 7.9% (4.9% diagnostic ERCP, 9.2% therapeutic ERCP, in detail: 3.8% acute pancreatitis, 2.1% cholangitis, 1.3% bleeding, 0.2% perforation, 0.5% other respectively). The total mortality was 0.1% (three cases of death). The frequency of complications increased with the number of procedure at the papilla Vateri in patients, who underwent needle knife papillotomy in combination with standard papillotomy.

Adolescent↗
PubMed1999

[Problems in diagnosis and therapy of juxtapapillary, tubulovillous adenoma].

UNLABELLED: Tubulovillous adenoma of the duodenum have a high potential for malignant transformation. An exact preoperative staging and an accurate histological examination are essential in order to choose a proper therapeutic strategy. We report on difficulties in the diagnostic and therapeutic process of a patient with a tubulovillous, juxtapapillary, duodenal adenoma. The adenoma had been resected by means of submucosal excision after infiltrative growth had been excluded endosonographically and malignancy had been ruled out by the histological examination of a taken biopsy. Furthermore no malignant changes had been found in the resected material. However an early recurrence of the tumor questioned the correctness of the first diagnosis. In fact, a retrospective histological examination of the resected specimen revealed an adenocarcinoma, which had been overlooked primarily. Finally the patient underwent duodenopancreatectomy and remains without signs of tumor recurrence so far. CONCLUSIONS: 1. Microinvasion of the submucosa can not be excluded endosonographically. Therefore endosonography can not specify the dignity of an unknown tumor with a sufficient safety, especially if there is only an intramural growth of the tumor without transmural spread. 2. Because of high recurrence rates and a distinct frequency of malignant transformation of duodenal adenomas, a submucosal resection should only be performed in high-risk patient. 3. In that patients the resected material has to be examined as accurately and subtly as possible to rule out a submucosal microinvasion. 4. Based on the above mentioned radical surgery (duodenopancreatectomy) should be performed in all normal risk patients with juxtapapillary adenomas.

Adenocarcinoma↗
PubMed1998

Gastric wall abscess, a rare endosonographic differential diagnosis of intramural tumors: successful endoscopic treatment.

Abscesses in the gastric wall are extremely rare. As the mucosa remains intact in most cases, clear differential diagnosis is required in order to distinguish the condition from the more frequent intramural mesenchymal tumors. Endoscopic ultrasonography provides a valuable tool for imaging intramural tumors, but this approach does not allow a definitive assessment of malignancy. We report about two patients with intramural abscesses in the gastric wall. Endosonography showing eccentric tumors from the gastric wall in the two patients. The endosonographic image was inhomogenous, the wall layer structure of the gastric wall was not preserved. A laparotomy was carried out on the first patient. In the second case, the diagnosis was easy, as pus was emptying from a small opening in the mucosa, which had already been detected at gastroscopy. Endoscopic intervention was carried out based on the endosonographic findings. In one patient, mucosa and submucosa were opened by a needle knife. These cases show that gastric wall abscesses do not have a typical endoscopic ultrasound appearance. However, endosonography is an essential method prior to endoscopic interventional therapy.

Abscess↗
PubMed1998

[Value of endosonography in diagnosis of diffusely growing stomach carcinomas].

The diagnosis of diffuse type gastric carcinoma is very difficult. The delay of diagnosis is often due to false-negative endoscopic and histologic evaluation. The architecture of the stomach can be clearly visualized by endosonography. Therefore, already minor destructions of the gastric layers can be found. The endosonographic picture includes the presence of the layers, which are larger and of irregular contour. In infiltrating gastric cancer typically the submucosal layer and the muscularis are concentrically enlarged and appear folded. Based on the endosonographic picture diffuse type gastric carcinoma has been diagnosed in 32 patients. When compared to the histologic diagnosis after gastrectomy or autopsy the accuracy of the endosonographic diagnosis was 87.5%, (28 out of 32 patients). From the remaining four patients diagnosed to have diffuse type gastric cancer by endosonography three patients turned out to have malignant infiltrating tumors of different histologies. Therefore, the positive predictive value of endosonography in detection of infiltrating malignant tumors was 96.8% in our group. In contrast the accuracy of preoperative histologic diagnosis by biopsies was only 58%. Suspicious results of gastroscopy, especially in combination with a negative biopsy, should lead to further evaluation by endosonography to detect diffuse type gastric cancer earlier.

Adenocarcinoma, Scirrhous↗
PubMed1991

Amphibian Mauthner cells.

Presently available data on anatomical, electrophysiological, and behavioral aspects of the Mauthner cell in amphibians are reviewed. Urodelian Mauthner cells appear morphologically distinct from those in anurans with respect to their abundant somatic dendrites, axon cap structures, lack of nodes of Ranvier, and size of axon collaterals. The presence of Mauthner cells does not seem to correlate with the presence of a tail or with an aquatic life-style in either larvae or adults, as they are also found in terrestrial adults, as well as in species without an aquatic larval stage. Electrophysiological data on Mauthner cell circuits are available for only two anuran species and indicate some interspecific differences. Special attention is given to a comparison of startle responses in larval and adult anurans and their possible relationship to Mauthner cell activities. Because of specific differences in Mauthner cell activities, as well as in startle response performance, it is argued that amongst the various ichthyopsid species Mauthner cells may have been adapted to modified functions due to the diverse morphoecological situations in which they are found.

Amphibians↗
PubMed1986

Mauthner neurons survive metamorphosis in anurans: a comparative HRP study on the cytoarchitecture of Mauthner neurons in amphibians.

Giant medullary neurons were revealed in adult Xenopus laevis and Rana esculenta following HRP injections to the spinal cord. These neurons were identified as Mauthner neurons because (1) they have the same position and orientation as the larval Mauthner neurons, i.e., they lie at the level of the VIIIth nerve root. (2) they have two large dendritic trees that for each species are similar to those of the larval Mauthner neurons, (3) they are clearly distinguishable from other large reticular neurons, (4) they have close connections with the VIIIth nerve afferents, (5) they have a decussating descending axon, the largest of the adult brainstem, and (6) they have a reduced axon cap, i.e., a dense neuropil without cap dendrites. Mauthner neurons were also identified in adult Xenopus muelleri, Hymenochirus curtipes, Hyla cinerea, Rhacophorus leucomystax, and Kalula pulchra. No Mauthner neuron was identified in larval or adult Bombina bombina or Bufo bufo or in adult Bufo terrestris, Bombina orientalis, or Scaphiopus holbrookii. Cytoarchitecture and the elaborate dendritic trees were also revealed in urodeles. Mauthner neurons of terrestrial forms (Ambystoma tigrinum, Paramesotriton chinensis) exhibit a less-extensive branching of the "lateral line" dendrite but otherwise show no signs of involution or regression compared to aquatic forms (Siredon mexicanum, Cynops pyrrhogaster). No Mauthner neuron was identified in larval or adult Ichthyophis kohtaoensis. Besides the topographical relations between Mauthner neurons and afferent fibers from the lateral line and the VIIIth nerve we could demonstrate a projection of trigeminal and mesencephalic neurons onto the soma of the amphibian Mauthner neuron.

Ambystoma↗
PubMed1984

Projection patterns of lateral-line afferents in anurans: a comparative HRP study.

Primary projections of the anterior and posterior lateral-line nerves were traced by means of transganglionic transport of horseradish peroxidase in species belonging to five of the six anuran superfamilies. Both anterior and posterior lateral-line nerve afferents each enter the brain via a single root which divides into two or more bundles. These bundles carry fibers from neuromasts only. No separate dorsal fascicle and no ampullary organs as in urodeles and gymnophions have been found. All bundles join in the neuropil of the nucleus intermedius to form ascending and descending fascicles. Two distinct fascicles are found in species showing little collateralization. No fasciculation is found in species with an elaborate telodendritic arborization. Afferents of the anterior lateral-line nerve run ventromedially and those of the posterior lateral-line nerve dorsolaterally within the ipsilateral nucleus intermedius neuropil. Rostrally they terminate in the vicinity of the eminentia granularis and caudally in the vicinity of the calamus scriptorius. The metamorphic changes in the alar plate do not support the hypothesis of Larsell ('34) as to a change in function of second-order lateral-line neurons into second-order auditory neurons. The rostral part of the nucleus intermedius shows numerous degenerating neurons at metamorphic climax whereas the caudal part becomes part of the nucleus caudalis of adult anurans. Besides the members of the Pipoidea, there is at least the genus Bombina which retains parts of the lateral-line system. The term "dorsal island," its relevance for any part of the anuran brain, and the possible relation between absence of electroreception and the development of the nucleus dorsolateralis are discussed.

Afferent Pathways↗