RESUMEN
As colonoscopy is often painful, a premedication appears to be indispensable. Commonly, benzodiazepines, i.e. midazolam, alone or in combination with analgesic drugs are used. Besides all advantages, midazolam especially is known to have the risk of oversedation and respiratory depression. Therefore it should be used at minimal dose. In a double-blind, randomized study, three premedication-schedules of midazolam (mid) plus ketamine (ket) were compared in 33 patients, aged between 8 and 60 years, with regard to safety and acceptance by patients and endoscopist. I: ket 1 mg/kg+mid 0.1 mg/kg, max. 5 mg II: ket 1 mg/kg+mid 0.05 mg/kg, max. 2.5 mg III: ket 0.75 mg/kg+mid 0.1 mg/kg, max. 5 mg Oxygen-saturation, heart rate and blood pressure were recorded as well as the evaluations of sedation, cooperation and complaint of pain. To assess the recovery-time of the patients, the reaction time and the attention were evaluated by "Wiener's determination apparatus" and "test d2", respectively, before and at 1, 2, 3 and 4 hours after premedication. Medication I resulted in heavy sedation, good cooperation and amnesia but had the strongest tendency towards hypoxemia. Under schedule III, reduced cooperation and acceptance were seen due to a strong experience of pain. The best conditions during the examination with regard to cooperation, experience of pain and acceptance were found after premedication II without relevant depression of vital parameters. It can be concluded that midazolam can be used at minimal recommended doses as premedication for colonoscopy if combined with ketamine in a sufficient analgesic dosage.
Asunto(s)
Colonoscopía , Ketamina , Midazolam , Premedicación , Adolescente , Adulto , Presión Sanguínea/efectos de los fármacos , Niño , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Combinación de Medicamentos , Femenino , Humanos , Inyecciones Intravenosas , Ketamina/administración & dosificación , Masculino , Memoria/efectos de los fármacos , Midazolam/administración & dosificación , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Tiempo de ReacciónRESUMEN
Within a 4-year period, 24 patients were treated by internal biliary drainage using self-expanding wall stents. In 3 patients, a benign and in 21 patients a malignant obstruction were present. The stents were successfully placed in all cases with an incomplete tumour coverage in three cases. Complete relief of icteric symptoms was seen in 18 out of 24 cases. Acute complications requiring additional treatment occurred in 5 patients. Average survival time was 93 days for malignant disease and 26 months for benign lesions. Cumulative patency after 200 days was 63% for stents placed in malignant obstructions. Stents in benign obstructions remained open in all cases.
Asunto(s)
Colestasis Intrahepática/terapia , Stents , Anciano , Anciano de 80 o más Años , Colestasis Intrahepática/epidemiología , Colestasis Intrahepática/etiología , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosAsunto(s)
Anestesia , Colonoscopía , Ketamina , Midazolam , Premedicación , Adolescente , Adulto , Presión Sanguínea/efectos de los fármacos , Niño , Método Doble Ciego , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Ketamina/efectos adversos , Midazolam/efectos adversos , Persona de Mediana EdadRESUMEN
A benign circumferential stenosis of the left hepatic duct was successfully treated with a self-expanding flexible metallic stent in a 70-year-old woman. Multiple intrahepatic stones were also removed percutaneously after dilatation of the tract up to a 24F diameter.
Asunto(s)
Conductos Biliares Intrahepáticos , Cateterismo , Anciano , Enfermedades de los Conductos Biliares/terapia , Cateterismo/instrumentación , Colelitiasis/terapia , Constricción Patológica/terapia , Diseño de Equipo , Femenino , Humanos , LitotriciaRESUMEN
In a 37-year-old woman with recurrent stenosis of a biliary digestive tract anastomosis and subsequent formation of bile stones, current methods of percutaneous management were useful in dilating the stenotic areas but could not remove a single bile stone within the left hepatic duct. It was successfully treated by using extracorporeal shock wave lithotripsy (ESWL) without major side effects.
Asunto(s)
Conductos Biliares Intrahepáticos , Colelitiasis/terapia , Conducto Hepático Común/cirugía , Yeyunostomía , Litotricia , Complicaciones Posoperatorias/terapia , Adulto , Cateterismo , Drenaje/métodos , Femenino , HumanosRESUMEN
A new system for endoscopic implantation and explantation of large-bore biliary endoprostheses is presented. This technique permits corrective placement of prostheses dislodged during implantation, as well as explantation and replacement through the biopsy channel of the endoscope in a single sitting. The method has been successfully employed in 10 patients.
Asunto(s)
Enfermedades del Conducto Colédoco/cirugía , Drenaje/instrumentación , Endoscopía , Prótesis e Implantes , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Intubación , Masculino , Persona de Mediana EdadRESUMEN
ERCP was performed in 57 patients who had undergone Billroth II resection. Cannulation of the papilla of Vater was successfully accomplished in 31 cases (55%). The success rate of ERCP was clearly dependent on the type of Billroth II resection presenting.
Asunto(s)
Enfermedades de las Vías Biliares/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica/métodos , Gastrectomía/métodos , Hepatopatías/diagnóstico por imagen , Enfermedades Pancreáticas/diagnóstico por imagen , Humanos , Complicaciones Posoperatorias/diagnóstico por imagenAsunto(s)
Enfermedades Intestinales/diagnóstico , Tuberculosis Gastrointestinal/diagnóstico , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Intestinales/diagnóstico por imagen , Enfermedades Intestinales/patología , Masculino , Radiografía , Tuberculosis Gastrointestinal/diagnóstico por imagen , Tuberculosis Gastrointestinal/patologíaRESUMEN
1. If endoscopy leads to the suspicion of an exulcerated and/or polypous carcinoma of the colon, surgical intervention is the primary therapy. Histological classification of the tumour should be effected by means of endoscopic biopsy. 2. (Familial) adenomatosis of the colon requires colectomy. 3. Broad-based polypi resembling a lawn where a large wound area must be expected by electrocoagulation (risk of perforation), and pediculate polypi of the (rare) size of 3 cm and more (risk of haemorrhage) should not be resected via endoscopy but by surgery. 4. Solitary or multiple polypi of the colon not covered by points 1 to 3 above, are primarily for reasons of diagnosis an indication for endoscopic polypectomy. Biospy in the case of adenomas to clarify the histological structure and to obtain qualitative and quantitative information regarding malignant degeration, must be discouraged (""partial diagnosis''.) 5. Basing on the current state of knowledge it is assumed that effective prohylaxis of cancer is achieved by the endoscopic removal of benign adenomas of the colon. 6. It is also assumed that effective cancer therapy can be realised by the endoscopic removal of adenomas which have already undergone malignant degeration (adenoma with severe cellular atypia, invasive differntiated adenocarcinoma in the head of the adenoma.)