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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Abdominal imaging 4 (1979), S. 367-377 
    ISSN: 1432-0509
    Keywords: Malignant extrahepatic cholestasis ; Bile duct endoprosthesis, percutaneous transhepatic insertion ; Bile duct endoprosthesis, function and complication
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A Teflon endoprosthesis for permanent bile drainage was inserted in 13 patients following percutaneous transhepatic puncture and catheterization of the bile duct system. Twelve patients had extrahepatic cholestasis because of a malignant tumor, whereas one patient had chronic inflammation involving the hepatoduodenal ligament (secondary to Crohn's disease) with obstruction of the extrahepatic bile ducts. The drainage periods varied from 1 week to 8 months. The endoprosthesis was regarded as partially effective in seven patients whereas in six cases the drainage through the endoprosthesis was insufficient and external bile drainage through a percutaneous transhepatic catheter was necessary. Infection of the bile duct system during the drainage period with a percutaneous transhepatic catheter and/or bile duct endoprosthesis occurred in 10 patients. Spontaneous dislocation of the endoprosthesis occurred in varying degrees in five patients. One patient developed an intrahepatic aneurysm adjacent to the puncture tract and died because of liver insufficiency following therapeutic embolization of the aneurysm and most of the hepatic arteries by injection of gelfoam particles into the common hepatic artery. Patients in whom palliative treatment by insertion of a permanent bile duct endoprosthesis may be suitable were defined.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0509
    Keywords: Obstructive jaundice ; Percutaneous transhepatic intubation ; Biliary decompression ; Preoperative drainage ; Palliation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Percutaneous transhepatic intubation and combined internal-external drainage of the biliary system was performed in 15 patients with occlusion of the extrahepatic bile ducts due mainly to cholangiocarcinoma, metastases of the hepatoduodenal ligament, and tumors of the periampullary region. The technique is described and the value of the procedure in temporary decompression and combined internalexternal bile drainage prior to radical surgery is demonstrated. Its advantages as a palliative method are evident in far-advanced malignancy when extensive and complicated surgical procedures are ill-advised.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Abdominal imaging 4 (1979), S. 323-329 
    ISSN: 1432-0509
    Keywords: Liver cirrhosis ; Portal venous hypertension ; Esophageal varices ; Endoscopy ; Esophageal phlebography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Twenty patients with portal hypertension due to cirrhosis were examined by esophagoscopy and percutaneous transhepatic esophageal phlebography. Esophageal varices were found in 18 cases at endoscopy and in 19 cases at esophageal phlebography. There was little correlation between the findings of the two methods with respect to the size and number of esophageal varices. At endoscopy the subepithelial and submucosal varices were reliably detected. At esophageal phlebography differentiation between intrinsic (i.e. subepithelial and submucosal veins) and peri-esophageal veins was not possible. Negative findings at esophageal phlebography do not rule out esophageal varices.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1432-1440
    Keywords: TRH ; Brain ; Pancreas ; Human ; Plasma ; Selective blood sampling
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Endogenous TRH levels were determined in plasma obtained selectively via percutaneous transhepatic and femoral catheterization. TRH was measured using a very sensitive RIA method. In the pancreatic veins, internal jugular vein, left testicular vein, and other described veins, normal peripheral levels were found. An involvement of the TRH degrading enzyme (TDE) or a rapid intravasal dilution leading to normal peripheral TRH levels in the veins leaving the brain or pancreas, respectively, is discussed.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 354 (1981), S. 55-68 
    ISSN: 1435-2451
    Keywords: Malignant extrahepatic cholestasis ; Fine-needle PTC ; Transhepatic bile drainage ; Bile duct endoprosthesis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung 30 Patienten mit extrahepatischer Cholestase aufgrund eines malignen Tumors erhielten eine permanente, percutan-transhepatisch eingesetzte Gallengangs-Endoprothese. Als Prothese wurde ein Teflon-Tubus (AD/ID 4,0/3,0 mm) ohne Seitenlöcher (13 Fälle) oder mit Seitenlöchern (17 Fälle) verwandt. Die Dauer der Gallendrainage durch die Endoprothese betrug 1– 32 Wochen. Die Drainagefunktion der Endoprothese ohne Seiten öcher wurde als partiell effektiv in 7 Fällen und als insuffizient in 6 Fällen Vorgetragen auf der 61. Tagung der Deutschen Röntgengesellschaft, Köln, 15.-17. Mai 1980 eingestuft. Die Drainagefunktion der Endoprothese mit Seitenlöchern wurde als optimal in 4 Fällen, als partiell effektiv in 10 und als insuffizient in 3 Fällen bewertet. Die Dysfunktion der Endoprothese in 9 von 30 Fällen war auf fehlende Seitenlöcher, spontanen Verschluß oder spontanes Gleiten der Prothese zurückzuführen. 8 Patienten entwickelten Symptome einer Cholangitis. In vier Fällen trat eine Sepsis nach Einsetzen der Prothese auf. Ein Patient starb an den Folgen eines intrahepatischen Pseudo-Aneurysmas, das sich nach Läsion einer Segmentarterie als Folge der transhepatischen Drainage entwickelt hatte.
    Notes: Summary In thirty patients with extrahepatic cholestasis because of a malignant tumor a permanent bile duct endoprosthesis was inserted nonsurgically. As prosthesis a teflon tube (OD/ID 4.0/3.0 mm) was used without side holes (13 cases) or with side holes (17 cases). The bile was drained through the endoprosthesis during a period of 1–32 weeks. The drainage function of the endoprosthesis without side holes was classified as partially effective in seven cases and as insufficient in six cases. The drainage function of the endoprosthesis with side holes was judged as optimal in four cases, partially effective in ten and insufficient in three cases. The dysfunction of the endoprosthesis in nine of thirty cases was caused by lack of side holes, spontaneous occlusion or spontaneous dislocation of the prosthesis. Eight patients developed symptoms of cholangitis. In four cases sepsis occurred after insertion of the prosthesis. One patient died from the sequelae of an intrahepatic pseudoaneurysm, which had developed from a damaged segmental artery following the transhepatic bile drainage.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 360 (1983), S. 287-293 
    ISSN: 1435-2451
    Keywords: Digital radiography ; Aorto-iliac occlusive disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei 16 Patienten mit ausgedehntem aorto-iliacalem Gefäßverschluß wurde die digitale Subtraktionsangiographie (DSA) mit intraarterieller Kontrastmittelinjektion angewandt. Die präoperative Beurteilung der Gefäße distal des Verschlusses und die Darstellung der Beingefäße gelang mit der intraarteriellen DSA in ausgezeichneter Weise. Ein Vergleich mit der konventionellen Serienangiographie zeigt die hervorragende Kontrastverstärkung der DSA-Untersuchungsmethode. Das geringere örtliche Auflösungsvermögen ist bei der genannten Fragestellung nicht von Bedeutung. Der Hauptnachteil der Untersuchungsmethode war der begrenzte Durchmesser des Bildverstärkers (23 cm) der benutzten Röntgenanlage. Während die intravenöse DSA die Diagnose eines aorto-iliacalen Gefäßverschlusses ermöglicht, ist bei langstreckigem Gefäßverschluß und geringer Ausbildung von Collateralen nur durchintraarterielle Injektion des Kontrastmittels die Beurteilung der Gefäße distal des Verschlusses bis zur Trifurkation der A. poplitea möglich.
    Notes: Summary Sixteen patients with advanced aorto-iliac occlusive disease were examined with digital subtraction angiography (DSA) using intraarterial injection of contrast medium. The preoperative evaluation of the vessels distal to the occlusion and the visualization of the femoral and popliteal arteries were successfully performed with intraarterial DSA. As compared to conventional angiography the marked contrast enhancement of DSA is demonstrated. Less spatial resolution of DSA lacks importance as the herein discussed topic is concerned. The limited size (23 cm) of the image intensifier of the X-ray equipment used was a major drawback of the method. Using intravenous DSA aorto-iliac occlusion can be shown. In patients with long range vascular occlusion and sparse development of collaterals only intraarterial DSA can demonstrate the run-off vessels including the trifurcation of the popliteal artery.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 364 (1984), S. 453-453 
    ISSN: 1435-2451
    Keywords: Jaundice ; Biliary drainage ; Duodenopancreatectomy ; Ikterus ; Gallenwegsdrainage ; Duodenopankreatektomie
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Die retrospektive Analyse umfaßt 200 Patienten, die wegen Neoplasmen oder chronischer Pankreatitis pankreatektomiert worden waren. Die Hospitalletalität lag bei 2,5%. Komplikationen traten nicht nur durch die Drainage der Gallenwege selbst auf, sondern waren auch im p. op. Verlauf nach Pankreasresektion in dieser Gruppe erhöht. Komplikationsrate bei 111 ikterisehen Patienten: ohne vorherige Gallenwegsdrainage 11%, 3 Relaparotomien, bei Patienten nach Gallenwegsdrainage 30%, 6 Relaparotomien. Ein hepatorenales Syndrom beobachteten wir bei keinem Patienten. Eine Entlastung der Gallenwege als Vorbereitung zur Duodenopankreatektomie scheint nach diesen Ergebnissen nicht nötig, sondern gefährdet im Gegenteil den Patienten.
    Notes: Summary After pancreatectomy for cancer or chronic pancreatitis 200 patients were analyzed in a retrospective fashion. Hospital lethality was below 2.5%. Only 11% of the complications occurred as a result of the drainage procedure itself. The incidence of complications following pancreatectomy was even higher in the group of patients after biliary drainage (30%, 6 relaparotomies) than in the group without preoperative biliary decompression (11%, 3 relaparotomies). None of the patients developed hepatorenal failure. There seems to be no advantage associated with biliary drainage for obstructive jaundice before pancreatectomy. Far from reducing operative mortality, it increased perioperative morbidity.
    Type of Medium: Electronic Resource
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