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  • 1
    Electronic Resource
    Electronic Resource
    Einteilung und Behandlung von Gallengangverletzungen nach laparoskopischer Cholecystektomie (2000)
    Springer
    Der Chirurg 71 (2000), S. 166-173 
    Details
    ISSN: 1433-0385
    Keywords: Keywords: Laparoscopic cholecystectomy – Iatrogenic biliary injury – Classification – Treatment. ; Schlüsselwörter: Laparoskopische Cholecystektomie – iatrogene Gallengangverletzung – Klassifikation – Therapie.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die iatrogene Gallengangverletzung stellt eine schwerwiegende Komplikation der laparoskopischen Cholecystektomie dar. Sie umfaßt periphere Galleleckagen und Verletzungen des extrahepatischen Gallengangsystems. Ihre Incidenz ist im Vergleich zur konventionellen Cholecystektomie um das 2–3 fache erhöht. In unserem Zentrum wurden 108 Patienten wegen einer iatrogenen Gallengangläsion nach laparoskopischer Cholecystektomie behandelt. Während 68 Patienten erfolgreich endoskopisch therapiert werden konnten, war bei 34 Patienten eine chirurgische Intervention erforderlich. Bei 6 Patienten mit einem peripheren Galleleck war die alleinige percutane äußere Drainage ausreichend. Für die Gallengangverletzungen wird unter Berücksichtigung der Ätiologie, der Lokalisation und des diagnostischen Intervalls eine neue Klassifikation vorgeschlagen, aus der sich diagnostische und therapeutische Konsequenzen ableiten lassen.
    Notes: Abstract. Iatrogenic bile duct lesions are serious complications during laparoscopic cholecystectomy and include biliary leakage and major bile duct injury. The incidence of biliary lesions following laparoscopic cholecystectomy is up to threefold higher than that of the open procedure. A total of 108 patients with bile duct lesions after laparoscopic cholecystectomy were treated at our institution. Endoscopic treatment was successful in 68 cases, 6 patients were treated by external drainage, and 34 patients required surgical therapy. Selection criteria for the type of treatment included the etiology, anatomical situation, and diagnostic interval of the biliary lesion. We suggest a classification of bile duct injury and a proposal for diagnosis and treatment of these complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040051033
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  • 2
    Electronic Resource
    Electronic Resource
    Diagnostik und endoskopische Therapie beim zentralen Gallengangskarzinom (1999)
    Springer
    Der Onkologe 5 (1999), S. 490-498 
    Details
    ISSN: 1433-0415
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Klatskin-Tumore sind cholangiozelluläre Karzinome, die sich im Bereich der Hepatikusgabel manifestieren [20]. Ihre funktionelle Bedeutung für den Galleabstrom resultiert aus ihrer Lokalisation und ihrer Wachstumsform. Ihre Resektabilität hängt von der Tumormasse und der zentrifugalen Ausbreitung in die Hepatikusgänge ab [3, 5, 19, 24]. Der diagnostische Goldstandard für die exakte Ausbreitungsdiagnostik ist nach wie vor die endoskopische retrograde Cholangio-Pankreatikographie (ERCP) [7, 13, 14]. Zum Diagnosezeitpunkt sind die meisten Klatskin-Tumore nicht mehr kurativ resektabel [5, 18]. Wird die Cholestase nicht behandelt, kommt es zu einem progredienten Leberversagen. Ziel endoskopischer Therapieverfahren ist die gezielte Galleableitung mit dem Erhalt von ausreichend funktionstüchtigem Parenchym [11, 21]. Für die Therapieplanung ist eine umfassende präinterventionelle Bildgebung des gesamten Gallenwegssystems erforderlich. Hierbei spielt die Magnetresonanz-Cholangio-Pankreatikographie (MRCP) eine zunehmend wichtigere Rolle [14]. Sehr hoffnungsvoll sind multimodale präoperative Therapieansätze, die zuvor inoperable Klatskin-Tumore wieder in eine kurativ resektable Situation überführen [1, 12, 30]. Neue Ansätze ergeben sich unter anderem durch die intrakavitäre photodynamische Therapie [4, 25].
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007610050390
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  • 3
    Electronic Resource
    Electronic Resource
    Intestinal disease in acquired immunodeficiency: evaluation by CT (1997)
    Springer
    European radiology 7 (1997), S. 1419-1429 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Human immunodeficiency virus ; Bowel disease ; CT ; AIDS ; Cytomegalovirus ; Colitis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Intestinal symptoms affect most AIDS patients at some point in their disease. The purpose of this study was to evaluate the use of CT in this setting. A total of 339 abdominal CT exams were reviewed for signs of intestinal disease. Abdominal CT scans of 45 patients with intestinal symptoms were compared with colonoscopy and histologic data. The CT results were correlated with CD4 + T-lymphocyte counts and patient survival. More than 14 % of all abdominal CT exams displayed signs of enteric disease. Of the 45 patients studied with both CT and colonoscopy, 35 (78 %) had signs of intestinal disease by CT. Of these 35 patients, colonoscopic signs of an intestinal lesion were found in 29 and histologic proof of disease was established in 30 cases. Colonoscopy and histology detected 8 lesions missed by CT. There were 14 cases of unspecific colitis, 15 cases of cytomegalovirus (CMV) colitis, and 4 cases of enteric tuberculosis as per biopsy. Five patients presented with Kaposi's sarcoma and 1 with a non-Hodgkin's lymphoma. Neither colonoscopic nor CT signs of intestinal disease did reliably distinguish between histologic subgroups. Specifically, CMV colitis could not be distinguished from unspecific colitis. CD4 + T-lymphocyte counts for histologic subgroups were not significantly different, either. No colonoscopic or histologic feature predicted survival, whereas low CD4 counts and ascites on CT indicated a poor prognosis. Whereas CT detects signs of intestinal disease in most AIDS patients, these signs remain largely unspecific. Colonoscopy and biopsies provide no consistently valid standard with which to compare CT because of controversial sensitivity and specificity of these methods. The CT technique detects small bowel as well as extraintestinal disease. Therefore, CT is an important diagnostic modality in abdominal disease of immunocompromised patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300050310
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    Paper (German National Licenses)
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