Biomedical subjects

W F Caspary

Publications and source records attributed to W F Caspary.

At least 73 records · Page 4Linked to original sources

PubMed2000

Perihepatic lymph nodes as a marker of antiviral response in patients with chronic hepatitis C infection.

OBJECTIVE: In patients with chronic hepatitis C, the sonographically determined total perihepatic lymph node volume reflects liver histology and viremia. The aim of this prospective study was to assess whether the response to antiviral therapy is reflected by changes in the total perihepatic lymph node volume. SUBJECTS AND METHODS: In 59 patients with chronic hepatitis C infection. the total perihepatic lymph node volume was assessed using sonography before the initiation of antiviral treatment, at the end of treatment, and at the end of a 6-month follow-up period. Hepatitis C viremia was assessed by reverse transcription-polymerase chain reaction assay at the same time points. Liver biopsy was performed in all patients before therapy and in 40 of the 59 patients 6 months after therapy. RESULTS: At the end of follow-up, the total perihepatic lymph node volume was significantly smaller in the 15 patients with a sustained virologic response than in the 44 patients who failed to respond to treatment (0.5+/-0.3 ml versus 2.0+/-1.2 ml; p<0.0001). In the group of sustained virologic responders, the decline of the perihepatic lymph node volume was associated with an improvement in liver histology. CONCLUSION: Total perihepatic lymph node volume changes according to the antiviral response and leads to progressive normalization of the perihepatic lymph node volume in sustained virologic responders. A decrease in the perihepatic lymph node volume is associated with an improvement in liver histology.

Adult↗

PubMed2000

Food viscosity as determinant for adaptive growth responses in rat intestine: long-term feeding of different hydroxyethyl celluloses.

Carbohydrate gelling agents can be regarded as being representative for the soluble and viscous fractions of dietary fibre. Their dietary concentration affects the consistency of the ingested food as well as the dilution of nutrients and energy. By feeding hydroxyethyl cellulose (HEC) differing in molecular mass, and thus in its viscosity properties, only the consistency of the diet was modified. Three HEC (of low (LV), medium (MV) and high viscosity (HV)) were employed in a 6-week feeding study with female rats to evaluate the effect of the viscosity on adaptive responses of intestinal growth variables. Each of the HEC was added in three increasing concentrations (8, 16, and 32%, w/w) to a fibre-free control diet to yield nine test groups besides a fibre-free and an additional, fibre-rich, cereal-based control group. Except for the highest concentration of the high viscosity product (32% HV-HEC), the dilution of the energy density of the diet was almost completely compensated by an increased food intake. With the same exception, energy utilisation was not impaired and, therefore, body-weight gains in the test groups were not significantly different from that in the control. Most other changes, e.g. increases in small intestinal length, mucosal DNA content, caecal and colonic weight, not only depended on the dietary concentration but also on the viscosity of HEC in a manner that either increasing the viscosity at a given dietary concentration or increasing the dietary concentration at a given viscosity led to the same results. These findings clearly prove the important role of the viscosity of the lumen content, as a mere physico-chemical factor, in determining adaptative growth responses in the intestinal tract of rats.

Animals↗

PubMed1999

[Extracorporeal shockwave lithotripsy in cholecystolithiasis using a new type of minilithotripter].

BACKGROUND AND OBJECTIVE: Extracorporeal shock wave lithotripsy (ESWL) of gallstones has until now required fixed, nearly room-sized and expensive equipment. It has become even less cost-effective with an increase in the number of laparoscopic cholecystectomies. The authors have technically modified a mini-lithotripter, used for dissolving salivary stones, for application against gallstones (by changing the energy spectrum and depth of focus). PATIENTS AND METHODS: 125 consecutive patients with solitary gallstone underwent lithotripsy according to a standard protocol (including oral litholysis), 64 of them (average age 42.5 +/- 9.3 years; 44 women, 20 men) by conventional ESWL (with the Modulith), 62 (average age 41.6 +/- 10.1 years; 43 women, 13 men) with a modified mini-lithotripter (Minilith). Clinical and sonographic follow-up took place at 1, 3, 6 and 12 months. Quality of life was documented according to a point score (GIQL), developed specially for patients with gastrointestinal conditions. RESULTS: The mini-lithotripter applied significantly lower voltage and more shock-wave impulses per treatment than the conventional ESWL (p < 0.01), while patient tolerance, measured with a visual analogue scale, was the same. Application of the mini-lithotripter was easier and quicker than with conventional ESWL, namely 31 +/- 8 min vs 41 +/- 12 min (p < 0.01). Frequency of adequate stone fragmentation per patient was the same for both methods, 2.2 +/- 0.5 applications with the mini-lithotripter vs 1.6 +/- 0.3 with conventional ESWL (p < 0.01). There was no significant difference between the methods with regard to improved quality of life (increase of GIQL scale of 16% with the conventional ESWL, 14% with the mini-lithotripter) or freedom from stone at 1 year after lithotripsy (conventional ESWL: 80%, mini-lithotripter: 82%). Colics recurred in 15 of 64 patients receiving conventional ESWL, and in 13 of 61 in the mini-lithotripter group (difference not significant). There were no other complications. CONCLUSION: The cheaper mini-lithotripter, costing only a third of the conventional ESWL, is equally effective in the dissolution of gallstones.

Adult↗

PubMed1999

[Adult-onset Still's disease. Differential diagnosis in recurrent pharyngitis, fever of unknown original and excessive hyperferritinemia].

HISTORY AND PHYSICAL EXAMINATION: Six weeks before admission a 43-year old previously healthy woman got right-sided pharyngitis, accompanied with Herpes labialis and oral candidiasis. Two weeks later she travelled to a holiday in the Caribbean. During the first week of holiday she developed pharyngitis again, this time accompanied with fever and arthralgies. Therapeutic trial with antibiotics, antimalaric drugs and antiamoebics, given at the holiday resort, did not reduce fever. Immediately after return to Germany a therapeutic trial with imipenem was was attempted, without any apparent improvement. At admission, the patient was febrile, had pinky patchy exanthema and arthralgias. EXAMINATIONS: At admission, abnormal findings included anaemia (Hb 8.8 mg/dl), severe leukocytosis (35.3/nl), increased ESR (43/89 mm), CRP (24.2 mg/dl) and ferritin (5751 micrograms/l). Ultrasound examination revealed mild splenomegaly. Computed tomography of the abdomen and chest were without apparent abnormalities. TREATMENT AND CLINICAL COURSE: Infection, autoimmune diseases and neoplasia were ruled out. The diagnosis of adult onset Still's disease was established on the basis of a typical triad of symptoms (fever, exanthema, arthritis). Treatment with 100 mg/d prednisolon (started intravenously) was beneficial for fever and arthralgia, and resulted in the normalisation of laboratory findings. After gradual reduction in the corticosteroid dosage, maintenance treatment with 20 mg/d prednisolon was continued over following months. CONCLUSION: Recurrent prodromal pharyngitis and excessive hyperferritinaemia are, in addition to the triad fever-exanthema-arthritis, further important diagnostic criteria of adult onset Still's disease.

Adult↗

PubMed1999

Mediastinal lymph nodes demonstrated by mediastinal sonography: activity marker in patients with cystic fibrosis.

PURPOSE: To evaluate the potential diagnostic role of mediastinal sonography in patients with cystic fibrosis (CF), we screened the mediastinum of adult CF patients with and without signs of infection and healthy controls. METHODS: Fifty-four consecutive adult patients with CF and 53 healthy volunteers underwent high-resolution mediastinal sonography. The paratracheal region and aorticopulmonary window of each subject were examined for lymph nodes. Each patient was screened for clinical signs of infection. RESULTS: Lymph nodes were detectable in the mediastinum of 39 of 50 CF patients (78%); the mean total lymph node volume was 1.5 +/- 1.7 cm3. Lymph nodes were detectable in the mediastinum of 31 of 50 controls (62%); the mean total lymph node volume in this group was 0.3 +/- 0.3 cm3 (p < 0.001). In the 30 CF patients with signs of infection, the mean total lymph node volume was larger (2.0 +/- 1.8 cm3) than in the 20 CF patients without signs of infection (0.7 +/- 0.9 cm3; p = 0.002). CONCLUSIONS: These results indicate that lymph node volume determination by high-resolution mediastinal sonography may help assess inflammatory activity in patients with CF.

Adolescent↗

PubMed1999

[Tube feeding in malnutrition].

Malnutrition is known to be very common in geriatric patients. The incidence is ranging from 30 to 60% of all patients. Therefore, indication for nutritional support via nasogastric or percutaneous tubes is frequently given. Since percutaneous endoscopic gastrostomy (PEG) has several advantages over nasogastric tube feeding including reduced risk of tube displacement and blockage, and higher patient acceptance, it has become the method of choice in enteral tube feeding. Complication rates are low provided that guidelines for enteral tube feeding are considered. Early home enteral nutrition contributes to patients quality of life.

Aged↗

PubMed1999

Mediation of differentiating effects of butyrate on the intestinal cell line Caco-2 by transforming growth factor-beta 1.

BACKGROUND: Beside their role as the main energy source in the colonic mucosa, short chain fatty acids were found to act as potent antiproliferative and differentiation agents in various cancer cell lines. It has recently been shown that butyrate also induces TGF-beta 1 mRNA in human keratinocytes, suggesting that TGF-beta 1 may play a role in butyrate induced cell differentiation. AIM OF THE STUDY: The objective of our study was to investigate the possible role of exogenous and endogenous TGF-beta on butyrate induced differentiation of intestinal epithelium. METHODS: Studies were performed in Caco-2 cells, a cell line resembling functionally normal enterocytes. Cells, cultured in standard medium were studied over a 15-day period. Sodium butyrate (5 mM), TGF-beta 1 (2 ng/ml) or butyrate (5 mM) + anti-human TGF-beta 1 antibody (30 micrograms/ml) were added to the medium. At day 4, 8, 11 and 15 total protein content, alkaline phosphatase activity, lactate dehydrogenase activity and transepithelial resistance were measured. RESULTS: Under culture conditions both, butyrate and TGF-beta 1 inhibited growth accompanied by an induction of cell differentiation approved by increased alkaline phosphatase activity and transepithelial resistance. The differentiating effect of butyrate was accompanied by an increased endogenous TGF-beta 1, but not TGF-beta 2 expression in Caco-2 cells. Co-incubation of butyrate with anti-human TGF-beta 1 antibody suppressed at least in part the differentiating effects of butyrate. CONCLUSIONS: Our results directly implicate that the TGF-beta isoform TGF-beta 1 is necessary for butyrate-induced Caco-2 cell differentiation, but other molecular mechanisms may also play a role in the differentiation of this cell line.

Alkaline Phosphatase↗

PubMed1999

Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study.

BACKGROUND: Adequate patient sedation is mandatory for diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The short-acting anesthetic propofol offers certain potential advantages for endoscopic procedures, but controlled studies proving its superiority over benzodiazepines for ERCP are lacking. METHODS: During a 6-month period 198 consecutive patients undergoing routine ERCP randomly received either midazolam (n = 98) or propofol (n = 99) for sedation. Vital signs (heart rate, blood pressure, oxygen saturation) were continuously monitored and procedure-related parameters, the recovery time and quality (recovery score) as well as the patient's cooperation and tolerance of the procedure (visual analog scales) were prospectively assessed. RESULTS: Patients receiving propofol or midazolam were well matched with respect to demographic and clinical data, ERCP findings, and the performance of associated procedures. Propofol caused a more rapid onset of sedation than midazolam (p < 0.01). Clinically relevant changes in vital signs were observed at comparable frequencies with temporary oxygen desaturation occurring (< 85 %) in 6 patients in the propofol group and 4 patients receiving midazolam (not significant). However, an episode of apnea had to be managed by mask ventilation via an ambu bag (lasting 8 minutes) in one of the patients receiving propofol sedation. Mean recovery times as well as the recovery scores were significantly shorter with propofol (p < 0. 01). Propofol provided significantly better patient cooperation than midazolam ( p < 0.01), but procedure tolerability was rated the same by both groups of patients (not significant). CONCLUSIONS: Intravenous sedation with propofol for ERCP is (1) more effective than sedation with midazolam, (2) safe under adequate patient monitoring, and (3) associated with a faster postprocedure recovery.

Adult↗

PubMed1999

Sphincter of Oddi dysfunction after successful gallstone lithotripsy (postlithotripsy syndrome): manometric data and results of endoscopic sphincterotomy.

After successful gallstone lithotripsy, biliary pain recurs in about one third of patients. However, gallstone recurrence can be shown in only 40-60% of these patients. Therefore, other causes, such as sphincter of Oddi dysfunction (SOD), may be suspected. Twenty-two consecutive patients with recurrent biliary pain after successful gallstone lithotripsy without evidence of gallstone recurrence at ultrasonography were enrolled. Liver tests were elevated in 13 patients and ERC showed a dilated bile duct in nine. All 22 patients underwent sphincter of Oddi (SO) manometry, bile sample analysis for microlithiasis, endoscopic sphincterotomy (ES), and bile duct exploration with a Dormia basket. Thereafter, the patients were clinically followed at bimonthly intervals. SO manometry revealed SOD in 15/22 patients. This was more often the case in patients with initially larger (>2 cm) or multiple stones than after lithotripsy for solitary small stones (P < 0.01). Microlithiasis was detected in one patient, another patient had small biliary calculi at bile duct exploration (both without SOD). After ES, 14/15 patients with biliary SOD but none of the five without SOD improved (median follow-up: two years; P < 0.01). The one patient with CBD stones became symptom-free after ES, while the patient with microlithiasis improved after additional cholecystectomy only. Overall, ES proved to be the adequate therapy in 15/22 patients (68%, median follow-up: 22 months). After gallstone lithotripsy, SOD is found in about two thirds of patients with recurrent symptoms but without gallstone recurrence. In this group CBD stones or microlithiasis are rare. Therefore, SOD has to be suspected in this situation and ES gives favorable results, even when performed on a clinical basis only (without SO manometry).

Adult↗

PubMed1999

[Analysis of hepatic echo patterns in chronic hepatitis C].

AIM: Patients with chronic hepatitis C often present a bright echopattern of the liver. Our aim was to examine the relationship of the sonographic echotexture of the liver in relation to the histological findings in patients with chronic hepatitis C without cirrhosis. METHODS: The livers of 68 patients with chronic hepatitis C (40 male, 28 female, age: 39 +/- 9 years) were evaluated by high resolution ultrasound equipment (3.5 and 5 MHz). Histologic specimens were obtained at the same time. Grading and staging was performed according to the histological activity index. 70 healthy subjects (40 male, 30 female, age: 35 +/- 9 years, no histology) were examined as controls. RESULTS: A bright sonographic echotexture of the liver was found in 26/68 (38%) patients with chronic hepatitis C, which correlated with the degree of fatty infiltration in the liver. Other parameters of the histological activity index showed no significant correlation with the echotexture of the liver. Hypoechoic areas in the liver hilus were detected in 24/26 (92%) patients with chronic hepatitis C and a bright echotexture of the liver. In 6/70 (9%) healthy subjects a bright sonographic echotexture could be detected. CONCLUSION: Patients with chronic hepatitis C typically show a bright echotexture of the liver, which correlates mainly with the histological finding of fatty infiltration. A hypoechoic lesion next to the liver hilus is present in almost all patients with bright echotexture of the liver and is a sonographic sign of fatty infiltration of the liver, which might represent an area of less fat content and/or more fibrous tissue which could be due to different vasculature.

Adult↗

PubMed1999

Long-term results of endoscopic injection of botulinum toxin in elderly achalasic patients with tortuous megaesophagus or epiphrenic diverticulum.

BACKGROUND AND STUDY AIMS: Recent studies suggest that endoscopic injection of botulinum toxin (BTX) for achalasia is a safe procedure giving short-term relief of symptoms mainly in elderly patients (> 50 years). The aim of the study was to evaluate the clinical efficacy of periodic BTX treatments in high risk achalasia patients. PATIENTS AND METHODS: A total of 20 consecutive achalasia patients, aged > 60 years (11 women; 71+/-11 years), with general (ASA class III or IV) and local risk factors (i.e. tortuous megaesophagus or epiphrenic diverticulum) for complications associated with pneumatic dilation, were treated by local injection of 100 U of BTX into the gastric cardia, using the four-quadrant technique. The patients were prospectively followed for a median period of 2 years (range 5-48 months), using a symptom score (1-14 points) and barium esophagograms. RESULTS: Symptomatic improvement (decrease of the symptom score > or = 3 points) was found in 16/20 patients (80%), 6 weeks after the first BTX injection, and the cardia diameter increased from 2.1+/-0.7 to 3.2+/-1.2 mm (P < 0.01) (data are means +/- SD). Those patients who initially responded to BTX treatment developed a symptomatic relapse after a median follow-up of 5+/-2 months. They were treated by subsequent BTX re-injections (2.5+/-1 sessions per patient, range 1-5) resulting in longer lasting symptom relief (10+/-3 months, P < 0.05 vs. initial BTX injection). At completion of the study, 14/20 high risk achalasia patients (70 %) treated with periodic BTX injections are still in clinical remission. One further patient died without relapse 6 months after a single BTX treatment as a consequence of progressive heart failure. Four patients who did not respond to BTX injection were successfully and uneventfully treated by careful pneumatic dilation (n = 3) or percutaneous endoscopic gastrostomy (n = 1). CONCLUSION: Endoscopic botulinum toxin injection has reasonable long-term efficacy and safety in elderly achalasia patients who are at increased risk with regard to pneumatic dilation.

Aged↗

PubMed1999

[Intestinal B-mode sonography in patients with endemic sprue. Intestinal sonography in endemic sprue].

AIM: The value of ultrasonography in the diagnosis, follow-up and for the detection of complications in patients with celiac sprue has not yet been sufficiently evaluated. A pronounced back and forth motility with echo-rich hump reflexes in a fluid-filled small bowel with a reduction of Kerckring's plicae circulares and with a loss of their density and uniformity was empirically defined as a diagnostic sign of celiac sprue. In the present study, the sonographic signs of celiac sprue were examined as an indicator of active sprue. METHOD: 50 patients with histologically proven celiac sprue were examined with real time ultrasonography (3.5-7 MHz). The detection or exclusion of the defined sonographic signs of celiac sprue with intensified motility and reduction of Kerckring's plicae circulares with a loss of their density and uniformity were evaluated by two independent examiners and documented without knowledge of the clinical findings. The clinical activity (active vs. remission) was assessed according to clinical criteria (diarrhea, steatorrhea, weight loss). 38 healthy subjects and 50 patients with Crohn's disease served as controls. RESULTS: In all 138 patients and controls adequate visualization of the bowel was achieved. In 16/50 (32%) patients with active celiac sprue changes of motility and reduction of Kerckring's plicae circulares with a loss of their density and uniformity were detected, whereas all 34/50 (68%) of patients with celiac sprue in remission did not have this pattern. In none of the controls with Crohn's disease or in the healthy subjects comparative sonographic signs of active celiac sprue were observed. In four patients with active celiac sprue a circumscript echopoor tumor of the small bowel wall could be sonographically detected, which turned out to be T-cell lymphoma in three and a carcinoma of the small intestine in one patient. An increased number of and/or enlarged mesenteric lymph nodes were found in patients with active celiac sprue. CONCLUSION: Changes of motility and reduction of Kerckring's plicae circulares with loss of density and uniformity at ultrasonography are a reliable indicator of active celiac sprue.

Adult↗

PubMed1999

Diseases of the small intestine.

During the past 10 years considerable progress and increase of knowledge on small intestinal diseases has been achieved. This short review will cover some selected small bowel diseases including coeliac disease, Whipple's disease, rare congenital enteropathies, non-steroidal anti-inflammatory drug enteropathy and autoimmune enteropathy.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1999

Superoxide: a major factor for stress protein induction in reoxygenation injury in the intestinal cell line Caco-2.

BACKGROUND/AIMS: Acute intestinal ischemia is followed by cellular destruction and loss of mucosal barrier function. Posthypoxic injury of cellular proteins leads to the synthesis of heat shock proteins. The role of oxygen radicals in this process, however, is not fully established. METHODS: In the present study, using the intestinal cell line Caco-2, we investigated the relationship between the synthesis of the heat shock protein HSP70, detected by Western blot and oxygen radicals as well as lactate dehydrogenase (LDH) release, as measured in photometrical tests. RESULTS: Various periods of hypoxia and 30 min of reoxygenation resulted in an increased generation of superoxide as measured by the tetrazolium base 3-(4, 5-dimethylthiazol-2-yl)2,5-diphenyltetrazoliumbromide. The inhibitor of superoxide dismutase (SOD), diethyldithiocarbamate (DDC) increased and addition of SOD decreased intracellular superoxide levels. HSP70 synthesis was detectable after 2 h of hypoxia. Similar to superoxide production, DDC increased and SOD reduced the HSP70 synthesis. In contrast, the increased LDH release from the cells observed after hypoxia was not significantly altered by DDC and SOD. CONCLUSION: The production of superoxide correlates with HSP70 induction, but not with LDH release. We conclude that hypoxia/reoxygenation induces heat shock protein production, a result of protein damage, by increased superoxide generation, whereas superoxide does not correlate with membrane damage in Caco-2 cells.

Adenosine Triphosphate↗

PubMed1999

Nondispersive infrared spectrometry for 13CO2/12CO2-measurements: a clinically feasible analyzer for stable isotope breath tests in gastroenterology.

BACKGROUND: 13C-urea breath tests have become clinical routine for the diagnosis of Helicobacter pylori infection and other isotope breath tests have been invented e.g. for gastric emptying or quantitative liver function testing. Recently, isotope-selective nondispersive infrared spectrometers (NDIRS) have been developed for the analysis of the 13CO2/12CO2-enrichment in breath. In this study, we prospectively tested the validity of a newly developed NDIRS in comparison to isotope ratio mass spectrometry (IRMS). METHODS: 142 patients with dyspeptic symptoms were tested for Helicobacter pylori infection using the 13C-urea breath test. The isotope ratio analysis of the breath samples was performed in duplicate both using IRMS and NDIRS. RESULTS: The results of the baseline-corrected 13CO2-exhalation values between IRMS and NDIRS were in excellent agreement. The mean difference between both methods was 0.28 +/- 1.93 delta/1000. Evaluating the qualitative urea breath test results in reference to IRMS as the reference the NDIRS had a sensitivity of 97.8% and a specificity of 98.9%. CONCLUSION: The isotope-selective nondispersive infrared spectroscopy is going to become a reliable, but low-cost and easy-to-operate alternative to expensive isotope ratio mass spectrometry in the analysis of 13C-breath tests.

Adult↗

PubMed1999

Peri-hepatic lymphadenopathy in primary biliary cirrhosis reflects progression of the disease.

OBJECTIVE: We prospectively investigated the peri-hepatic lymph node volume in patients with primary biliary cirrhosis (PBC) and healthy controls to evaluate the correlation with histology, biochemical and immunological features. MATERIALS AND METHODS: The total peri-hepatic lymph node volume in the liver hilus was evaluated by high-resolution ultrasound in 67 consecutive patients with PBC and in 43 healthy controls. Stages I-IV of PBC were biochemically, immunologically and histologically proven in all patients. RESULTS: Adequate visualization of the liver hilus was achieved in 59/67 patients (88%) with PBC and in 39/43 healthy controls (91%). Lymph nodes in the liver hilus were sonographically detected in all 59 patients with PBC and in 26/39 healthy controls (67%) with adequate visualization of the liver hilus. The mean peri-hepatic lymph node volumes were: stage I (n = 9): 0.8 +/- 0.5 ml; stage II (n = 28): 2.4 +/- 1.5 ml; stage III (n = 21): 4.2 +/- 2.3 ml; stage IV (n = 9): 3.2 +/- 1.0 ml. The peri-hepatic lymph node volume did not significantly correlate with cholestasis, liver function tests or the immunological status. CONCLUSIONS: Enlarged lymph nodes in the liver hilus are sonographically detectable in almost all patients with PBC. The total peri-hepatic lymph node volume in patients with PBC reflects histological stage, i.e. larger lymph nodes are observed in more advanced disease.

Adult↗

PubMed1999

[Gastrointestinal complications of adult patients with cystic fibrosis].

Cystic fibrosis (CF) is the most common autosomal recessive disease in the Caucasian population. The primary cellular defect, the reduced expression of the cystic fibrosis transmembrane conductance regulator (CFTR), leading to a chloride secretory defect, is present in all epithelial cells of endodermal and mesodermal origin and has been described in sweat glands, the airway epithelium and the small intestine, the colon and rectum, including the pancreas. In the upper GI-tract the most troublesome complaints and symptoms originating from the esophagus are peptic esophagitis or esophageal varices. In the small intestinal wall, the clinical expression of CF largely depends on the decreased secretion of fluid and chloride ions and the sticky mucous covering the enterocytes. Although CFTR expression in the colon is lower, the large intestine may be the site of several serious complications such as rectal prolapse, distal intestinal obstruction (DIOS), and intussusception. In recent years an increase in colonic strictures after the use of high-dose pancreatic enzymes, has been increasingly reported. CF has also been reported to be increasingly associated with a number of hepatic and/or biliary abnormalities, of which chronic cholestatic liver disease is by far the most relevant. Plugging of intrahepatic bile ducts with inspissated secretions is thought to play a major role in the pathogenesis. It has been estimated that about 15% of cystic fibrosis patients reveal serum liver enzyme abnormalities, but prevalence of liver involvement is likely to be higher. Oral bile acid therapy is promising, but its long-term benefits in terms of survival and prevention of major complications by liver cirrhosis remain to be established. Pancreatic dysfunction in cystic fibrosis (CF) is characterized by an insufficient pancreatic exocrine function. However, 10-15% of CF patients have pancreatic sufficiency and this status is genetically determined by one or two "mild" mutations in the CFTR.

Adult↗

PubMed1999

[A new papillotome for cannulation, pre-cut or conventional papillotomy].

UNLABELLED: A new papillotome was designed to overcome certain drawbacks of the needle-knife, that is most commonly used for precut sphincterotomies. The intention was to develop an instrument at least as good as the needle-knife or the Erlangen-type precut papillotome for precut procedures. In addition, it had to be suitable for direct cannulation of the biliary or pancreatic duct. PATIENTS AND METHODS: According to a prospective protocol 54 patients in whom a papillotomy was indicated were examined with the new instrument. The protocol allowed three futile attempts to cannulate or two inadvertant cannulations of the pancreatic duct with a standard cannula and hydrophilic guide wire before a precut was performed. The new baby-papillotome has a diameter of only 1 mm and a short 10 mm cutting wire. Similar to a guide wire it is introduced via a 6F- or 7F-introducer catheter. RESULTS: Cannulation of the desired duct (the bile duct in 48 patients, the pancreatic duct in five patients, Billroth II anatomy in three patients) was successful within one session in 98% (53/54). In one patient, the bile duct was successfully cannulated in a second session using the baby-papillotome, resulting in an overall success rate of 100%. Primary cannulation using the new papillotome without precut was obtained in 24% (13/54). Complications were mild pancreatitis in one patient and nonsignificant bleeding in three (immediate endoscopic hemostasis in all, no transfusions, no drop of hematocrit). There were no serious complications. CONCLUSION: The new baby-papillotome is suitable for precut as well as for primary cannulation. In this first series, the desired duct was cannulated in 98% within the first session with a low complication rate. Further studies of the new instrument seem desirable.

Catheterization↗