Spontaneous and antibody-dependent cellular immune reactions to ethanol-altered hepatoma cells

— Spontaneous cell-mediated cytotoxicity (SCMC), antibody-dependent cellular cytotoxicity (ADCC) and proliferative lymphocyte stimulation in alcoholic liver disease (ALD) were investigated. Peripheral blood lymphocytes (PBL) from eight patients with advanced ALD and nine normal controls were tested against hepatoma cells (PLC/PRF/5) as targets. Target cells were grown in either normal culture medium or medium supplemented with 1 and 5% ethanol, respectively, for 24 to 48 h. Ethanol-exposed hepatoma cells exhibited profound and characteristic morphological alterations. Ethanol preincubation, however, proved to be without effect on immune reactions. Provided that hepatoma cells are an appropr…

Electromagnetically generated extracorporeal shockwaves for fragmentation of extra-and intrahepatic bile duct stones: indications, success and problems during a 15 months clinical experience.

Electromagnetically generated extracorporeal shock waves (without waterbath) were applied after intravenous premedication with 10-15 mg diazepam and 100 mg tramadol in the treatment of 33 patients (aged 32 to 91 years) with multiple intrahepatic stones (n = 4) or huge common bile duct stones (n = 29, 18-30 mm in diameter), which could not be removed by conventional endoscopy. Stone disintegration was achieved in 70% of common bile duct stones and in all intrahepatic concrements after 800-7500 discharges, which were applied during one (n = 21), two (n = 6) or three sessions (n = 6). Apart from mild fleabite-like petechiae at the side of shock wave transmission no other side effects were obse…

The endoscopic measurement of intravascular pressure and flow in oesophageal varices.

COMPUTED TOMOGRAPHY TO PREDICT HARDNESS OF BILEDUCT STONES BEFORE ENDOSCOPIC LITHOTRIPSY

Endoskopische Diagnostik und Therapie der akuten biliären Pankreatitis

Endoskopische retrograde Cholangiopankreatikographie (ERCP) und endoskopische Papillometrie (EPT) sind wesentliche Saulen der Diagnostik und Therapie der akuten biliaren Pankreatitis. Patienten mit Pankreatitis sowie klinischen und laborchemischen Hinweisen auf eine extrahepatische Cholestase sollten unbedingt endoskopiert werden. Die EPT ermoglicht eine effektive und komplikationsarme Therapie, wenn die Pankreatitis mit Konkrementen in den Gallenwegen oder der Papille assoziert ist. Bei Patienten mit akuter Cholezystitis bei Cholezystolithiasis lassen sich mittels endoskopischer Manometrie funktionele Storungen der Papillenmotilitat nachweisen, die als Ursache von Cholestase und Pankreatit…

Investigation of the Effect of Duodenoscopy on Sphincter of Oddi Manometry

To investigate whether endoscopy affects sphincter of Oddi (SO) manometry, three patients who had undergone previous cholecystectomy and had a T-tube in situ for drainage were studied. Manometry was performed using a perfused triple lumen manometry catheter (diameter 1.7 mm), which was advanced into the SO lumen through the T-tube. SO motility, baseline pressure, common bile duct pressure and duodenal pressure were monitored before and during endoscopy while the tip of the endoscope was in the mouth, esophagus (upper third, precardial), stomach and duodenum. Endoscopy and even a moderate insufflation of air necessary to pass the pylorus and inspect the papilla of Vater did not affect the pa…

Characterisation of a new subgroup of autoimmune chronic active hepatitis by autoantibodies against a soluble liver antigen.

Autoantibodies against a soluble liver antigen (SLA) were detected in 23 patients with HBsAg-negative chronic active hepatitis (CAH) but not in 502 patients with various other hepatic and non-hepatic disorders or 165 healthy blood donors. Anti-SLA-positive serum samples were negative for antinuclear and liver-kidney-microsomal antibodies, markers of two subgroups of autoimmune-type CAH, 6 anti-SLA-positive patients were negative for all autoantibodies sought. Most of the anti-SLA-positive patients were young women (2 men, 21 women; mean age 37 years) with hypergammaglobulinaemia (mean 3.2 g/l, range 1.8-5.3 g/l); 18 of the 23 patients had received immunosuppressive treatment and all respond…

Pneumatoceles and pneumothoraces complicating staphylococcal pneumonia: treatment by synchronous independent lung ventilation.

A 54 year old man with a staphylococcal sepsis developed staphylococcal pneumonia complicated by multiple pneumatoceles and bilateral tension pneumothoraces caused by bronchopleural fistulae. Excessive enlargement of the right sided pneumatoceles and a tension pneumothorax not improved by drainage led to mediastinal shift and compression of the right lung. Reversal of the mediastinal shift and closure of the bronchopleural fistulae was achieved by assisted independent lung ventilation.

NITROGLYCERINE DILATATION OF SPHINCTER OF ODDI FOR ENDOSCOPIC REMOVAL OF BILEDUCT STONES

Extrakorporale Stoßwellenlithotripsie von Gallenblasensteinen: Wie viele Patienten sind geeignet?

The proportion of patients with gallbladder stones suitable for extracorporeal shockwave lithotripsy (ESWL) was analysed prospectively in 200 patients aged 17-76 years (62 males, 138 females) with symptomatic cholecystolithiasis. Criteria for inclusion were clinical symptoms, solitary stones (diameter 10-30 mm) or up to three stones with comparable total volume, contractile gallbladder, no calcification of stones, normal biliary tract anatomy. To check these criteria a step-by-step diagnostic procedure was instituted which consisted of history, ultrasonography with contractility test, abdominal X-ray film, computed tomography measurement of stone density, and endoscopic retrograde cholangio…

Electromagnetically generated extracorporeal shock waves for gallstone lithotripsy: in vitro experiments and clinical relevance.

. First generation shock wave sources have been proved to disintegrate gallstones effectively, but they require the immersion of the patient's body in a tank of water. A recently developed second generation shock wave source (Siemens-Lithostar, Erlangen, FRG) generates shock waves electromagnetically. It presents several novel features. In particular the waterbath can be omitted and due to lower shock wave pressure general anaesthesia is not required. In vitro studies showed that 36 out of 38 gallstones (11–30 mm in diameter) could be disintegrated. Two concrements resisting lithotripsy were pure white cholesterol stones. Independent of shape, size, and composition (cholesterol or pigment) …

PENTAZOCINE HAMPERS BILE FLOW

Elevated Pressure in the Dorsal Part of Pancreas Divisum

Summary In 6 patients with upper abdominal pain of unknown origin presenting with pancreas divisum, the pressure in the pancreatic duct was measured via the minor papilla into which in these patients the main part of the pancreatic duct system drains. For comparison intraductal manometry via the major papilla (papilla of Vater) was performed in 8 patients with normal pancreatic duct system. The pressure in the pancreatic duct of the control group was 10.5 ± 0.9 mm Hg. whereas in the patients with pancreas divisum it was 23.7 ± 1.3 mm Hg. The results demonstrate that in patients with pancreas divisum, intraductal pressure may be largely increased even in the fasting state.

Electromagnetically Generated Extracorporeal Shock Wave Lithotripsy and Adjuvant Combined Oral Litholysis for Therapy of Symptomatic Gallbladder Stones

A prospective study was conducted to evaluate effectivity, problems and adverse effects of extracorporeal shock wave lithotripsy (ESWL) using a newly developed electromagnetic biliary lithotriptor (Lithostar Plus, Siemens, Erlangen, FRG) for the treatment of selected patients presenting with symptomatic cholecystolithiasis. In addition to generally accepted criteria for the selection of patients, gallbladder contractility was established and pigment stones were excluded by computed tomography (CT). 80 out of 486 patients (63 females, 17 males, mean age 36, range 17-76 years) were selected for ESWL using a standardized diagnostic program. 62 out of 80 patients participating in the study had …

Is ERCP manometry useful in the choice of treatment of stones of the common bile duct?

To verify the appropriateness of sphincterotomy as the treatment of choice of choledocholithiasis, since 1980 we have been using endoscopic retrograde cholangiopancreatographic (ERCP) manometry of the sphincter of Oddi (SO). This method allows direct investigation of SO motor activity and provides useful information regarding the presence of benign papillary stenosis (BPS). Thirty-four patients were investigated because the radiological examination indicated BPS might be present. Of these, 20 had common bile duct (CBD) stones, while the remaining 14 presented with biliarylike pain and one or more of the following: CBD dilation (larger than 12 mm); emptying of the ERCP contrast medium took l…

Lithotripsy of gallbladder stones in 1992: Improved indications and actual results

ESWL of gallbladder stones and subsequent adjuvant oral dissolution is a safe and comfortable therapy of symptomatic cholecystolithiasis. This method is limited on highly selected 10 to 15% of patients. Recent experience indicates that the ideal indication is given in patients with radiolucent solitary gallstones (diameter ≤2 cm) which are harboured in a gallbladder with unimpaired contractility. 1 year after ESWL 80% of those patients present with a stone free gallbladder. Computed tomography of gallstones may probably improve selection of patients and therapeutic success.

Epidemiologie und Voraussagbarkeit der Varizenblutung

Bis zu 80% der Patienten, mit Leberzirrhose entwickeln eine Osophagusvarizenblutung, welche auch heute noch in bis zu 30% letal endet. Parameter, die Patienten mit hohem Blutungsrisiko identifizieren, sind schwerwiegende Lebererkrankungen mit reduziertem Allgemeinzustand und Ascites (Child C), grose Osophagusvarizen, die ein „red color sign“sowie flachenhafte Rotungen aufweisen, sowie ein hoher Osophagusvarizendruck, der 12 mmHg ubersteigt.

Radiologische Diagnostik bei Dysphagie und Motilitätsstörungen des Ösophagus

Ergebnisse und Komplikationen von 616 perkutanen transhepatischen Gallenwegsdrainagen

During nine years, percutaneous transhepatic biliary drainage was carried out 616 times on 563 patients in the Department of Radiology, University of Mainz Medical School. 50.3% were pre-operative and 39% were palliative. More than 80% were necessitated by malignant lesions. Subsequent improvements in biochemical measurements were observed in 82.4% of patients. Complications of the procedure led to the death of five patients (0.8%) and required surgery in nine patients (1.5%). The following complications were observed: biliary peritonitis in 0.6%, sepsis in 1.9%, bleeding in 1.9% and fever higher than 38 degrees C in 16.2%.

The Effect of Glyceryl Trinitrate on the Intravascular Oesophageal Variceal Pressure in Patients with Cirrhosis and Portal Hypertension

Glyceroltrinitrat (GTN) fuhrt zur Erschlaffung der glatten Muskulatur von Blutgefasen. Es wurde daher fur moglich gehalten, das es den Pfortaderhochdruck bei Patienten mit Leberzirrhose vermindern konnte. Mit der kurzlich beschriebenen endoskopischen Feinnadelpunktion von Osophagusvarizen konnte der Einflus von GTN auf den intravasalen Osophagusvarizendruck (IOVD) gemessen werden. Drei Minuten nach sublingualer Gabe von 2.2 mg GTN fiel der IOVD bei 10 Patienten mit Varizen Grad III von 22.8 ± 2.0 mmHg auf 12.0 ± 0.4 mmHg (p◄0.005) und bei sechs Patienten mit Varizen Grad II von 16.3 ± 0.4 mmHg auf 10.0 ± 0.4 mmHg (p◄0.005). Unsere bisherigen Ergebnisse lassen vermuten, das GTN zur Blutstill…

Administration of Second-Generation Extracorporeal Shock Waves without Waterbath for Fragmentation of Extra- and Intrahepatic Bile Duct Stones

First-generation extracorporeal shock-wave sources disintegrate 97% of kidney stones [1, 2]. Recently, in selected patients gallbladder and common bile duct stones were also treated. The technique available so far, however, requires immersion of the patient’s body in a tank of degassed water. The procedure is therefore inconvenient, time consuming, and relatively expensive. The high pressure of shocks (up to 1000 bar) generated by underwater spark discharge causes pain, and general anesthesia is necessary in most patients [3, 4].

Gallensteinbehandlung durch extrakorporale Stoßwellenlithotripsie und adjuvante orale Lyse Standort und Perspektive

Gallensteintherapie im Wandel? Die nachfolgende Arbeit versucht eine erste Standortbestimmung und die Entwicklung von Perspektiven der Stoswellenlithotripsie von Gallensteinen. Welche Patienten sind fur dieses neue Behandlungsverfahren geeignet? Wie sind die Erfolgsaussichten?

Biliary Pancreatitis: Endoscopic Diagnostic and Therapeutic Techniques

Acute pancreatitis constitutes one of the most hazardous emergencies in clinical gastroenterology. Although the diagnosis “biliary pancreatitis” is often used in clinical practice for patients presenting with concrements in the biliary tree or impacted in the papillary orifice [17, 32], the common phrase “biliary pancreatitis” has not so far been exactly defined. Patients with cholecystolithiasis may be included in this group, as well as patients with dysfunction of the sphincter of Oddi. Some authors have reported that juxtapapillary diverticula increase the risk for development of biliary pancreatitis [28].

Analysis of radiolucent gallstones by computed tomography for in vivo estimation of stone components.

. Successful oral litholytic and other non-operative therapies of gallstones require exact determination of the stone components. Since computed tomography (CT) provides highly sensitive measurement of density, we performed a study to evaluate whether CT measurement of stone density allows a prediction of the composition of radiolucent gallstones. Twenty-eight patients presenting with 29 radiolucent gallbladder (n= 17) or common bile duct stones (n=12) were included. Prior to operative or endo-scopic therapy the attenuation values (Hounsfield Units, HU) were assessed in vivo by CT under standardized conditions (Somatom II, 125 KV, 130 mAs). After surgical or endoscopic stone removal the con…