0000000000222632
AUTHOR
I. Helmreich-becker
Minilaparoscopy-guided spleen biopsy in systemic disease with splenomegaly of unknown origin.
With the advent of a minimally invasive laparoscopy technique, the advantages of diagnostic laparoscopy are being rediscovered. We report here on four patients with systemic disease of unknown origin and splenomegaly, in whom minilaparoscopy-guided splenic biopsy yielded a definitive diagnosis. Four patients with unclear systemic disease were studied using diagnostic minilaparoscopy and guided spleen biopsy, after failure of diagnostic work-up. Minilaparoscopic spleen biopsy revealed the diagnosis of a B-cell non-Hodgkin's lymphoma in two cases. In one patient, who had a history of Still's disease, the spleen biopsy showed granulocytic infiltration in the spleen typical of an acute episode …
Liver assessment and biopsy in patients with marked coagulopathy: value of mini-laparoscopy and control of bleeding.
Evaluation of liver disease in patients with a high risk of postbiopsy bleeding presents a diagnostic challenge. Mini-laparoscopy offers the possibility of coagulation of biopsy site and the additional advantage of macroscopic liver assessment. We wished to assess the value and safety of mini-laparoscopy with guided biopsy as a diagnostic approach in patients in whom percutaneous liver biopsy is considered contraindicated because of a marked coagulopathy.We investigated 61 consecutive patients with marked coagulopathy (prolonged international normalized ratio1.5, thrombocytopenia50/nl, or both; von Willebrand's disease/hemophilia). Diagnostic mini-laparoscopy with visually guided liver biop…
Post-infantile giant cell hepatitis in patients with primary sclerosing cholangitis and autoimmune hepatitis.
In post-infancy, multinucleated giant cell hepatitis is rare. Various conditions and diseases associated with post-infantile giant cell hepatitis have been described, but the pathogenesis remains unknown. In this paper we review the case reports of four patients (3 male, 1 female; aged 22 to 32 years) with primary sclerosing cholangitis and autoimmune hepatitis. The follow-up ranges from five to seven years. All patients showed cholestasis and repeated elevation of hepatic transaminases. Patients with viral infections, metabolic disorders and toxic influences were excluded. Histopathology of liver tissue in all four patients revealed giant cell formation with up to 20 nuclei in 20-70% of al…
Budd-Chiari Syndrom – eine seltene Manifestation der hereditären Thrombophilie
Das Budd-Chiari Syndrom ist eine seltene Manifestationsform der hereditaren oder erworbenen Thrombophilie. Bei einer 30 jahrigen Patientin konnte, nach anfanglichen diagnostischen Schwierigkeiten, ein BCS diagnostiziert und erfolgreich, durch portocavalen Seit-zu-Seit Shunt, behandelt werden. Bei der Chiari-Trias aus abdominellen Schmerzen, Hepatomegalie und Ascites mus das BCS in die differentialdiagnostischen Uberlegungen mit einbezogen und gegebenenfalls durch invasive Diagnostik ausgeschlossen werden. Therapiemoglichkeiten sind die Anticoagulation und die Anlage eines portosystemischen Shunts (TIPS oder chirurgischer Shunt). Eine Lebertransplantation kommt als ultima ratio bei Leberinsu…
Drug-induced hepatitis: a rare complication of oral anticoagulants.
Hepatotoxicity is a rare complication of coumarin anticoagulants. We present the case of a 56-year-old woman who developed a viral-hepatitis-like picture 8 months after mitral valve replacement and oral anticoagulation. Phenprocoumon-induced hepatitis was diagnosed after positive reexposure and improvement following withdrawal of the drug. There appeared to be cross-reactivity to warfarin since this drug led to a similar increase in alkaline phosphatase and gamma-glutamyl transferase after a few days of administration. Liver biopsy showed an acute viral-hepatitis-like picture. Anticoagulation was changed to a subcutaneous low molecular weight heparin and low-dose aspirin. Because of the wid…
Mini-Laparoscopically Guided Percutaneous Gastrostomy and Jejunostomy
Abstract Background: Percutaneous endoscopic tube placement can be problematic under certain circumstances: absence of transillumination of the abdominal wall, percutaneous jejunostomy in patients with a PEG tube and recurrent aspiration, enteral feeding access after gastrectomy, and obstruction of the upper GI tract. As an alternative in these problematic situations, a technique was developed for placing feeding tubes under visual control by using mini-laparoscopy. Methods: Placement of a feeding tube with mini-laparoscopy with the patient under conscious sedation was considered for 17 patients in whom standard PEG placement was impossible. Techniques used were the following: combined mini…
Safety and Feasibility of a New Minimally Invasive Diagnostic Laparoscopy Technique
Background and Study Aims: Laparoscopy combined with guided liver biopsy offers many advantages in the diagnosis and staging of chronic liver diseases and is superior to other diagnostic procedures. We developed a new minilaparoscopic technique and evaluated the utility of this minimally invasive laparoscopic system in the first 320 patients who underwent diagnostic assessment for liver disease or peritoneal carcinosis. Patients and Methods: Between July 1996 and February 1998, minilaparoscopy, with analgesia and sedation was carried out in 320 patients. It was done using a 1.9-mm optical instrument, which was inserted through the same 2.75-mm trocar as the Veress needle used for inflating …
Combined Therapy with Azathioprine, Prednisolone, and Ursodiol in Patients with Primary Sclerosing Cholangitis: A Case Series
No established medical therapy alters the progressive course of primary sclerosing cholangitis.To explore the potential usefulness of combined therapy with azathioprine, steroids and ursodeoxycholic acid (UDCA) in primary sclerosing cholangitis.Case series.University hospital in Mainz, Germany.15 patients with primary sclerosing cholangitis.Azathioprine (1 to 1.5 mg/kg of body weight per day), prednisolone (1 mg/kg per day initially, tapering to 5 to 10 mg per day) and UDCA (500 to 750 mg per day).Clinical and laboratory evaluation, liver biopsy, and endoscopic retrograde cholangiography (a30% change in stenosis was considered significant).After a median observation period of 41 months (ran…