Incidence of bleeding in 8172 percutaneous ultrasound-guided intraabdominal diagnostic and therapeutic interventions - results of the prospective multicenter DEGUM interventional ultrasound study (PIUS study).

Purpose: To analyse the incidence of bleeding after percutaneous ultrasound guided diagnostic and therapeutic intraabdominal interventions in a prospective multicentre study (DEGUM percutaneous interventional ultrasound study).

Materials And Methods: Within a time period of 2 years diagnostic and therapeutic intraabdominal interventions (with the exclusion of ascites paracentesis) performed percutaneously under continuous ultrasound (US) guidance were prospectively assessed using a pseudonymized standardized web site entry form. Number and type of intervention, operator experience, patient characteristics, medication, lab data as well as technical aspects of the procedure and bleeding complications were analysed according to the interventional radiology standards.

[Colorectal Carcinoma with Suspected Lynch Syndrome: A Multidisciplinary Algorithm].

Lynch syndrome is the most frequent hereditary cancer syndrome, accounting for approximately 3-5 % of all colorectal cancers. In addition, it is the most frequent predisposing hereditary cause of endometrial cancer and is also associated with gastric cancer, ovarian cancer, cancer of the urinary tract as well as several other cancers. In clinical practise Lynch syndrome is frequently not detected and many clinicians admit uncertainties regarding diagnostic procedures.

Gender-Specific Aspects of Lynch Syndrome and Familial Adenomatous Polyposis.

Background: The most frequent hereditary colorectal cancer (CRC) syndromes are Lynch syndrome and familial adenomatous polyposis (FAP), accounting for approximately 5% of the CRC burden. Both are characterized by an autosomal dominant mode of transmission and require an individualized approach of intensified screening and prophylactic surgery.

Methods: In this review, we provide an overview of the literature regarding gene- and gender-specific aspects of Lynch syndrome and FAP.

Ultrasound-guided, high-energy extracorporeal - shock-wave treatment of symptomatic calcareous tendinopathy of the shoulder.

Background: The objective of the present study was to test the effectiveness of ultrasound-guided high-energy extracorporeal shock-wave treatment in symptomatic chronic calcareous tendinopathy of the shoulder rotator cuff, and to assess the morphology of the hydroxyapatite deposits before and after this treatment.

Methods: The study involved 80 patients who suffered from calcification of the rotator cuff. These patients were treated with an instrument with electromagnetic induction of shock-waves (Doli-Lithotripter, Dornier, Munich, Germany) under continuous ultrasound location of the treatment focus.

[Transcutaneous sonography of the gastroesophageal junction in prospective comparison with endoscopy].

Background And Objective: Despite its practical value, few data exist on assessing the gastrooesophageal junction by transcutaneous sonography (TS). A prospective study was undertaken to compare TS and endoscopy (ES) of this region.

Patients And Methods: Between 1 September, 1994 and 31 May, 1995 TS of the lower oesophagus was followed by ES of this region in 211 patients (116 women, 95 men; mean age 58.

Ultrasound-guided extracorporeal shock wave lithotripsy of pancreatic ductal stones: six years' experience.

Extracorporeal shock wave lithotripsy (ESWL) and endoscopic sphincterotomy (EST) was performed in 35 patients suffering from pancreatic duct stones. Calculi disintegration and resolution of obstruction were achieved in all cases. Completely stone-free ducts were achieved in 16 patients (46%) while some peripheral asymptomatic stone material remained in 19 (54%).

[Extracorporeal shockwave lithotripsy (SWL) of common bile duct calculi without previous endoscopic papillotomy].

In 17 patients (8 men, 9 women; mean age 61.5 years) with problematic bile-duct stones (papilla endoscopically inaccessible, residual bile-duct stones after recent laparoscopic cholecystectomy or age below 25 years) the chances of successful treatment by ESWL without sphincterotomy were examined. In 15 patients with solitary stones measuring up to 14 mm "pulverization-ESWL" produced complete freedom from stones after spontaneous migration of fragments through the intact papilla.

[Endoscopic therapy in acute hemorrhage caused by duodenal diverticula].

History And Clinical Findings: A 70-year-old previously healthy woman had been feeling nauseous for one day and had passed several liquid tarry stools. A barium meal previously done as an out-patient had shown a duodenal diverticulum 3.5 cm in diameter with marked contrast-medium retention.

[Non-contact argon gas coagulation in flexible endoscopy of the gastrointestinal tract: in vitro studies and initial clinical experiences].

Diathermocoagulation is indispensable in interventional endoscopy. The argon beam coagulation represents an innovative electrocoagulation method, where high-frequency alternating current is conducted to tissues by ionized argon gas without contact. Before clinical application we performed in vitro studies to evaluate depth and diameter of tissue coagulation of fresh resectations from stomach, small intestine and colon.

[ESWL-therapy of pancreatic duct calculi].

In 23 patients suffering from pancreatic duct stones, extracorporeal shock wave lithotripsy (ESWL) was performed in combination with endoscopic sphincterotomy (EST). Calculi-disintegration and resolution of obstruction was achieved in all cases. Completely stone-free ducts were achieved in 7 patients, some peripheral asymptomatic stone material remained in 16.

[Chronic mesenteric ischemia--a rare differential diagnosis of Crohn disease].

A 59-year-old patient was treated for six years assuming Crohn's disease. Recurrent segmental colitis, spontaneous perforation of the jejunum and chronic weight loss were suggestive of this diagnosis despite a missing typical histology, even in the resected part of jejunum. Only unspecific inflammatory changes were found.

[Extracorporeal shockwave lithotripsy of bile duct calculi].

Shockwave therapy of bile duct stones is not dependent on difficult preconditions concerning stone-volume and -composition or subsequent lythic therapy. Its main indication is failure of endoscopic sphincterotomy (EST). Shockwave lithotripsy of bile duct stones--which may even be carried out even instead of EST in specific cases--is with a success rate of 80 to 95% as effective as shockwave lithotripsy in urology.

[Extracorporeal shockwave lithotripsy of gallbladder calculi].

Shockwave disintegration of gallbladder stones with lythic therapy of residual fragments is successful when all criteria of patient- and stone-selection, shockwave application and lysis are fulfilled. The "Four-S-stones" proved to be the best candidates: solitary, symptomatic, sonolucent in a sufficiently contractile gallbladder. The rate of complications is low.

[Extracorporeal shock wave lithotripsy of an impacted gallstone in cholecysto-antral fistula].

The endoscopic examination of a patient with gastrointestinal bleeding unexpectedly revealed a cholecysto-antral fistula with incipient penetration of a gallstone into the stomach (and presumably intermittent bleeding from the fistula rim). As endoscopic extraction was not possible and the stone impacted in the fistula was visible in the ultrasound scan extracorporeal shock-wave lithotripsy was carried out. An electrohydraulic lithotripter was used and 1,913 shock waves were applied at a maximum of 26,000 volts.

Ultrasonography and biliary extracorporeal shock-wave lithotripsy.

The results of shock-wave treatment of gallbladder stones depend to a very high degree on the quality and expertise of ultrasonography applied before, during, and after shock-wave disintegration of the stones. Ultrasonography is decisive in evaluating the inclusion criteria; it is the method of choice for directing the shockwave energy at the stones and monitoring the disintegration process. It is the only diagnostic modality to really demonstrate the gallbladder being free from stones.

[Extracorporeal shockwave lithotripsy of problem bile duct calculi].

ESWL is a new gentle, very effective, poor-risk technique in treatment of extrahepatic problematic bile-duct stones. This method might substitute surgical choledochotomy to a great extent. ESWL is a new therapeutic alternative to achieve nonoperative freedom of stones or, at least, to treat biliary obstruction in intrahepatic bile-duct stones, which are not treatable by endoscopic operative methods.

[Sonography and biliary extracorporeal shockwave lithotripsy].

Ultrasound is an indispensable tool for preliminary diagnosis ('filter function'), during treatment ('monitoring function') and in the followup examinations ('follow-up function') after shock wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which experience to date has shown to be rare.

[Sonography and biliary extracorporeal shockwave lithotripsy (ESWL)].

Ultrasound is an indispensable tool for preliminary diagnosis ("filter function"), during treatment ("monitoring function") and in the follow-up examinations ("follow-up function") after shock-wave lithotripsy of gallstones. It permits rapid and reliable assessment of the therapeutic outcome and early identification of complications, which present-day experience has shown to be rare.

[Ultrasound morphology of gallstones].

Using a subtile examination technique genuine information can be obtained from the interior of a gallstone--at least to a depth of 15 mm. This information should provide an indication of the homogeneous (crystalline) or inhomogeneous (non-cholesterol) structure of the stone. Further systematic use of differentiating gallstone ultrasonography could become a useful additional decision making criterion for selection of gallstones suitable for conservative treatment.

[Biliary extracorporeal shock-wave lithotripsy].

Since 1985/86, more than 200 patients with problematic intra- and extrahepatic bile duct stones were treated with ESWL. Results are excellent and comparable with ESWL's success-story in urinary stone disease, abandoning widely open surgery for bile duct stones. In gallbladder-stone treatment, ESWL (always combined with bile acid litholysis) is only promising or successful in a carefully selected subset (10 to 15%) of all symptomatic patients (with good gallbladder contractility, limited stone volume and sonolucent stones).

[Extracorporeal shockwave lithotripsy in gallstone perforation].

A 78-year-old man with rheumatoid arthritis, arteriosclerosis and cardiac arrhythmias (Lown grade IVb) was admitted to hospital because of haematemesis. Gastroscopy revealed a narrow, deformed duodenal bulb with a bleeding ulcer crater on the posterior wall and a mucosal protrusion 1 cm in diameter. In the course of the illness the duodenal bulb obstruction increased further and there was recurrent vomiting.

[Which factors promote chronic alveolar hypoventilation in patients with obstructive sleep apnea?].

The pathogenesis of obesity hypoventilation is incompletely understood. We investigated 505 patients with sleep apnoea in respect of determinants that correlate with chronic hypercapnia. 14 patients (2.