Detection and treatment of an aneurysma spurium of the arteria hepatica dextra after laparoscopic cholecystectomy.

BACKGROUND: Massive upper gastrointestinal hemorrhage can be the dominant symptom of decompensated liver cirrhosis, varices and ulcerations in the upper gastrointestinal tract. Postoperative complications are known to lead to these bleedings. Commonly, emergency endoscopy will be performed. Here we report of a patient with extensive bleeding caused by an aneurysma spurium of the arteria hepatica dextra induced by a laparoscopic cholecystectomy. The condition was diagnosed by the Doppler ultrasound scan of the liver. CASE PRESENTATION: Initially the source of the gastrointestinal bleeding was caused by an ulcus Dieulafoy in the jejunum which was stopped by clipping. Continous bleeding was observed and traced to a rare complication of a laparoscopic cholecystectomy due to a gallbladder empyema. After surgical intervention the patient developed an aneurysma spurium of the arteria hepatica dextra which was in communication with the small bowel. The successful treatment was performed by embolizing the aneurysma. CONCLUSION: The reasons for gastrointestinal bleedings are manifold. This case presents a seldom cause of a gastrointestinal bleeding due to an aneurysma of the hepatic arteria. The successful embolization was performed to ultimately stop the bleeding.

Comparability of localization data in transnasal and transoral esophagogastroduodenoscopy.

BACKGROUND: Esophagogastroduodenoscopy is an often-used and safe diagnostic method in gastroenterology. Transnasal esophagogastroduodenoscopy is now an established addition to the endoscopic instrumentarium. Although the two examination methods can be used alongside each other, there is a lack of studies on the comparability of the localization data obtained with the transoral and transnasal methods. METHODS: In 135 adult patients presenting for routine outpatient esophagogastroduodenoscopy, transoral esophagogastroduodenoscopy (TOG) was carried out after transnasal esophagogastroduodenoscopy (TNG), and the distance from the naris or incisors, respectively, to the esophagogastric junction was measured. RESULTS: The data for 135 patients were analyzed. With the transoral access route, the distance from the upper incisors to the cardia was a mean of 40.5 cm (SD ± 3.4 cm). In the transnasal examinations, the mean distance between the naris and the cardia was 45.6 cm (SD ± 3.5 cm). The correlation analysis showed a very close correlation between the peroral and transnasal data, with a correlation coefficient of r = 0.925. On the basis of the regression line calculated using these data, the formula TNG (cm) = 1.1 × TOG (cm) was developed. Using this formula, localization details obtained with one method can be converted into those for the other method. CONCLUSIONS: There is a strong correlation between the localization details obtained with the transnasal and transoral examination methods. The formula for converting localization details from one method to the other, presented here for the first time, is practicable for everyday use and allows rapid conversion.

Chemical gastritis after chronic bromazepam intake: a case report.

BACKGROUND: We describe a rare case of diffuse macroscopic discoloration and chemical gastritis due to chronic bromazepam intake. The chemical composition of pharmaceuticals has to be considered at endoscopy and it is evident that some chemical substances damage the epithelial tissue and lead to clinical symptoms. CASE PRESENTATION: Endoscopy was performed in an 82-year-old patient due to gastroesophageal reflux symptoms and epigastric pain. Gastroscopy showed a hiatal hernia and a scarred duodenal bulb. More striking was the yellow-brownish discoloration of the gastric and the duodenal mucosa. The gastric antrum and the duodenal bulb showed local discoloration that could not be rinsed off. The medical history indicated that bromazepam (6 mg) had been used daily as a sleeping aid in the previous two years. The histopathological findings showed appearances of chemical gastritis. Within the lamina propria and on the epithelial surface there were granules. There was no foreign body reaction to these granules. Corpus mucosa showed a mild chronic gastritis. CONCLUSIONS: If discoloration of the mucosa at endoscopy is seen, a careful drug history must be sought. This is the first case in literature that shows a chemical gastritis after bromazepam intake.

Computer-aided recording of automatic endoscope washing and disinfection processes as an integral part of medical documentation for quality assurance purposes.

BACKGROUND: The reprocessing of medical endoscopes is carried out using automatic cleaning and disinfection machines. The documentation and archiving of records of properly conducted reprocessing procedures is the last and increasingly important part of the reprocessing cycle for flexible endoscopes. METHODS: This report describes a new computer program designed to monitor and document the automatic reprocessing of flexible endoscopes and accessories in fully automatic washer-disinfectors; it does not contain nor compensate the manual cleaning step. The program implements national standards for the monitoring of hygiene in flexible endoscopes and the guidelines for the reprocessing of medical products. No FDA approval has been obtained up to now. The advantages of this newly developed computer program are firstly that it simplifies the documentation procedures of medical endoscopes and that it could be used universally with any washer-disinfector and that it is independent of the various interfaces and software products provided by the individual suppliers of washer-disinfectors. RESULTS: The computer program presented here has been tested on a total of four washer-disinfectors in more than 6000 medical examinations within 9 months. CONCLUSIONS: We present for the first time an electronic documentation system for automated washer-disinfectors for medical devices e.g. flexible endoscopes which can be used on any washer-disinfectors that documents the procedures involved in the automatic cleaning process and can be easily connected to most hospital documentation systems.

SEN virus does not affect treatment response in hepatitis C virus coinfected patients but SEN virus response depends on SEN virus DNA concentration.

AIM: To clarify the effect of SEN virus (SENV) infection on a combination therapy including interferon alfa (IFN-alpha) or pegylated-IFN with ribavirin in patients with chronic hepatitis and the effect of a combination therapy on SENV. METHODS: SENV DNA was determined by polymerase chain reaction in serum samples from 95 patients with chronic hepatitis C. Quantitative analysis was done for SENV H DNA. RESULTS: Twenty-one (22%) of 95 patients were positive for SENV DNA. There was no difference in clinical and biochemical parameters between patients with HCV infection alone and coinfected patients. The sustained response rate for HCV clearance after combination therapy did not differ between patients with SENV (52%) and without SENV (50%, n.s.). SENV DNA was undetectable in 76% of the initially SENV positive patients at the end of follow-up. SENV H response to combination therapy was significantly correlated with SENV DNA level (P=0.05). CONCLUSION: SENV infection had no influence on the HCV sustained response rate to the combination therapy. Response rate of SENV to the combination therapy depends on SENV DNA level.

SEN virus infection.

The SEN virus (SEN-V) belongs to a recently discovered group of DNA viruses whose members (SEN-V-D and SEN-V-H) are associated with post-transfusion hepatitis. It is a single-stranded circular, non-enveloped DNA virus of approximately 3600 to approximately 3800 nucleotides with at least three open reading frames (ORFs). Eight different strains of SEN-V have been identified and provisionally classified as members of the Circoviridae family, a group of small, single-stranded, non-enveloped circular DNA viruses that includes the TT virus (TTV), TUS01, SANBAN, PMV and YONBAN. Prevalences in different populations show great variability with marked differences between different countries and groups. Although parenteral transmission is very likely, other routes of transmission cannot be excluded. Mother to infant transmission has been demonstrated. The effect of SEN-V on chronic liver diseases has been studied. The influence of SEN-V on the response to HCV therapy was investigated in three studies, with contradictory results. Data for other acute and chronic liver diseases are sparse. Further studies are needed to define the pathogenesis and clinical importance of SEN-V infection.

A multiplex-PCR to identify hepatitis B virus--enotypes A-F.

Eight genotypes (A-H) of hepatitis B virus (HBV) are known with variations in nucleotide sequences greater than 8%. Several recent publications found that the clinical course and outcome of antiviral therapy depended on the genotype of the infecting HBV strain. Large epidemiological studies will require the availability of a system which is rapid, reliable and can be performed on a large number of samples. We have developed a multiplex-PCR assay which uses genotype-specific primer pairs for HBV genotypes A-F. These primer pairs specifically amplified HBV DNA of the respective genotype, either in single or in multiplex-PCR. Sensitivity of the assay was in the range of 10(4) genome equivalents.