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  • 1
    Electronic Resource
    Electronic Resource
    Value of laparoscopy in trauma ICU patients with suspected acute acalculous cholecystitis (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 361-365 
    Details
    ISSN: 1432-2218
    Keywords: Acalculous cholecystitis ; ICU ; Diagnostic laparoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Patients who require prolonged intensive care following traumatic injuries are at risk for developing acute acalculous cholecystitis (AAC). The diagnosis of AAC is often difficult to establish, resulting in increased morbidity and mortality in this critically ill population. We reasoned that diagnostic laparoscopy might provide a more accurate and timely method of diagnosis. Laparoscopy was performed in nine trauma ICU patients with suspected AAC. Four procedures were considered positive and five were negative. There were no false-positive or false-negative laparoscopic exams, and no procedure-related morbidity occurred. Comparison of multiple clinical, laboratory, and radiologic findings showed that only laparoscopy accurately distinguished between those patients with AAC and those without AAC. We conclude that diagnostic laparoscopy is safe and definitive in trauma ICU patients with suspected AAC and should be performed prior to proceeding with laparotomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00642431
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Flexible sigmoidoscopy (1997)
    Springer
    Surgical endoscopy and other interventional techniques 11 (1997), S. 113 -115 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Ruptured abdominal aortic aneurysm — Ischemic colitis — Flexible sigmoidoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The development of colonic ischemia following repair of ruptured abdominal aortic aneurysm (AAA) is associated with significant morbidity and timely diagnosis is essential. The purpose of this study was to determine the efficacy of endoscopy in the diagnosis of colonic ischemia and in prediction of need for resection. Methods: Patients who underwent postoperative lower endoscopy after ruptured AAA from 1986 to 1995 were reviewed for endoscopic findings, clinical course, and patient outcome. Results: A total of 80 patients had ruptured AAA during the study period, of which 56 survived for longer than 24 h postoperatively. Flexible lower endoscopy was done in 18 patients (32%) on an average of 4.4 days following AAA repair (range 1–16). Indications for initial endoscopy included early or bloody stools in 12 (67%), hemodynamic instability or sepsis in eight (44%), and acidosis in four (22%). The extent of the examination was sigmoid or descending colon in 13, cecum in four, and transverse colon in one. Endoscopic findings were normal in four patients. Five examinations showed only areas of hemorrhagic mucosa. Absence of full-thickness ischemia was confirmed by clinical course or autopsy in these nine patients. Two examinations demonstrated full-thickness necrosis which was confirmed at subsequent laparotomy. In six examinations, ischemia was noted but judged to be limited to mucosa only. Absence of full-thickness disease was demonstrated by laparotomy in three and subsequent course in three. Eight patients (57%) with initial abnormal examinations underwent repeat endoscopy showing improved interval appearance in seven cases and progression to full-thickness ischemia in one patient. Conclusions: Flexible sigmoidoscopy reliably predicts full-thickness colonic ischemia following repair of ruptured aortic aneurysms. Patients with non-confluent ischemia limited to the mucosa can be safely followed by serial endoscopic examinations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900309
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Rare bile duct anomalies (1994)
    Springer
    Surgical endoscopy and other interventional techniques 8 (1994), S. 329-331 
    Details
    ISSN: 1432-2218
    Keywords: Biliary anomalies ; Laparoscopic cholecystectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Anomalies of the biliary ductal system are not uncommon, and are of variable clinical significance. A case is reported of an extremely unusual variation, with the cystic duct entering the left hepatic duct. Preoperative delineation of the anomaly in this patient by endoscopic retrograde cholangiography assisted in the subsequent performance of a safe laparoscopic cholecystectomy. Awareness of potential biliary variations is one factor in avoidance of ductal injuries during laparoscopic surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00590964
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Endoscopic placement of nasojejunal feeding tubes in ICU patients (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 1211-1214 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Endoscopy—Nasojejunal feeding tube—ICU—Enteral nutrition—Gastric feeds
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Enteral nutrition is an important component in the management of critically ill patients, but it may be limited by gastric ileus and unreliable positioning of standard feeding tubes. The purpose of this study was to determine the risk, utility, and outcome of endoscopically placed nasojejunal feeding tubes (NJT) in intensive care unit (ICU) patients. Methods: We reviewed the records of all ICU patients who underwent endoscopic NJT placement from May 1995 to May 1997. A through-the-scope method was used with placement of either an 8-Fr or 10-Fr 240-cm tube. Comparison was made between tubes secured to a nasopharyngeal bridle and tubes secured without bridling. Results: A total of 66 NJT were placed in 56 patients. Previous gastric feeds had been attempted in 39 patients (70%) an average of 8.4 days prior to placing the NJT. Fifty tubes (76%) were placed in the ICU and 16 (34%) in the OR at the time of additional procedures. Procedure time ranged from 7 to 28 mins (mean, 15.2), and bridling was used in 24 of 66 placements (36%). Full caloric goal rates were achieved via 56 of 66 tubes (85%) at an average of 26.1 h after placement (range, 1–144). Goal rates were not achieved in 10 cases due to inadequate tube positioning in six, ileus in three, and early dislodgement in one. A procedure complication, consisting of aspiration, occurred in one case (1.5%). Length of tube use averaged 18.5 days (range, 1–74). Accidental tube dislodgement or migration occurred in 16 of 42 (38%) nonbridled tubes vs one of 24 (4%) bridled tubes (p 〈 .05). Conclusions: Endoscopic placement of nasojejunal feeding tubes in critically ill patients is a safe, quick, and reliable option for enteral nutrition. Full caloric goal rates can be achieved rapidly in a high percentage of patients, even in cases where previous gastric feeds have not been tolerated. Use of a nasopharyngeal bridling system for tube security significantly decreases the risk of migration or accidental tube dislodgement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00009623
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    1992 Scientific Session of the Society of American Gastrointestinal Surgeons (SAGES) Washington, D.C., USA, April 11–12, 1992 (1992)
    Springer
    Surgical endoscopy and other interventional techniques 6 (1992), S. 85-110 
    Details
    ISSN: 1432-2218
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02281090
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    Paper (German National Licenses)
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