ABSTRACT
Since January 1, 1986 all our diabetes mellitus patients have participated in a structured diabetes education programme of two weeks duration. A systematic review of 260 diabetic patients treated by us up to June 30, 1987, has shown that only 25 (9.6%) had been suitably informed about their disease. Necessary therapeutic consequences, such as strict dietetic measures, additional insulin therapy or intensified conventional insulin therapy, were more readily understood and accepted after the education course. The basic conditions present in a specialized rehabilitation clinic are more favourable in view of good longterm metabolic control than in the acute hospital or in general practice.
Subject(s)
Diabetes Mellitus/rehabilitation , Patient Education as Topic/methods , Rehabilitation Centers , Adult , Aged , Female , Germany, West , Humans , Male , Middle Aged , Patient Compliance , Self CareABSTRACT
Examination of 124 pancreatico-duodenal preparations obtained during surgery and of 250 pancreatic preparations at post-mortem has shown, that patients with chronic pancreatitis do have rather frequently cysts of the duodenal wall (38,5%). These cysts have a diameter of 2-100 mm. They are located in most cases in the submucosal layer as well as in the muscularis propria layer of the duodenal wall between pylorus and papilla. They lead to stenoses of the duodenum in 27% of the cases and they may be considered as a drainage barrier for pancreatic juice in 48.6% of the cases. They are lined with a single layer cylindrical or cubical epithelium; below the epithelium there are located rather frequently tubular glands (49.1%) and sometimes residues of Brunner's glands (7%) as well as ectopical pancreatic tissue (8.8%). The type of epithelial lining points to the fact, that these cysts may be considered as heterotopic formations of pancreatico-ductal tissue. On comparing the groups of patients with chronic pancreatitis with and without cysts of the duodenal wall it turned out that there was no difference between these groups in regard to histology of the disease, alcohol abuse, age and sex. Single cases described in the literature and 4 own cases show however, that chronic pancreatitis may be caused by primary cysts of the duodenal wall.
Subject(s)
Cysts/etiology , Duodenal Diseases/etiology , Pancreatitis/complications , Chronic Disease , Cysts/pathology , HumansABSTRACT
The vascularization of the Papilla Vateri was investigated by angiography, histology and morphometry in 55 samples obtained at autopsy; four main types may be distinguished. The bleeding risk accompanying endoscopic papillotomy in general is low because of the anatomy of the arterial supply of the papilla. The average diameter of the vessels in the plexus arteriosus papillae is about 0,98 mm, it is only 0,43 mm in the proximal part of the papilla (that is to say, the part adhering to the bile duct). The arteria retroduodenalis crosses the ductus choledochus on the average 37.5 mm from the tip of the papilla. In rare cases more excessive arterial bleeding may occur, since there is a crossing of the arteria retroduodenalis through the region of papillotomy in about 4% of the cases. A high bleeding risk exists during 8 days after the first of a multiple step papillotomy procedure, since during this period vascularization of the granulating tissue is still extensive.
Subject(s)
Ampulla of Vater/blood supply , Ampulla of Vater/diagnostic imaging , Ampulla of Vater/surgery , Autopsy , Endoscopy , Gastrointestinal Hemorrhage/complications , Humans , Radiography , RiskABSTRACT
Endoscopic retrograde pancreaticography (ERP) and secretin-pancreozymin test corrected for losses (SP test) were performed in 153 patients suspected to have pancreatic disorders in order to evaluate diagnostic significance of these procedures. Pancreatic sonography was done in addition in 110 of these patients. If pancreatic excretion was normal, ERP results turned out to be normal in the same patients as well. SP test involves rather extensive laboratory work-up, but it does yield the most precise results as far as diagnosis of chronic pancreatitis is concerned. For this reason, and because of the possible complications caused by ERP, ERP should be applied only, when surgery is considered. Results of SP test and sonography coincided rather well. Therefore, sonography, not doing any harm to the patient, does have its place in the diagnosis of chronic pancreatitis.
Subject(s)
Pancreatitis/diagnosis , Cholecystokinin/analysis , Chronic Disease , Clinical Enzyme Tests , Endoscopy , Humans , Methods , Pancreatitis/diagnostic imaging , Radiography , Secretin/analysis , UltrasonographyABSTRACT
Obstruction of the common bile duct can now be relieved by endoscopic electrosurgery. This report describes our experience with 267 patients. In 192 of 222 patients with choledocholithiasis all calculi were evacuated by endoscopic papillotomy (EP). The remaining patients had EP because of papillary stenosis. Complications of EP included nine instances of pancreatitis, seven of bleeding, and two perforations. In 2 of 32 patients having EP for papillary stenosis, restenosis has appeared on follow-up. The two fatalities were attributable to purulent cholangitis and acute bleeding. This required to manage these situations. The endoscopic method requires less hospitalization and recuperation. EP and stone extraction are the methods of choice for managing common duct obstruction in high risk patients before cholecystectomy, for retained or reformed stones after cholecystectomy, and for papillary stenosis.
Subject(s)
Ampulla of Vater/surgery , Biliary Tract Diseases/surgery , Electrosurgery/methods , Endoscopy/methods , Gallstones/surgery , Duodenum/injuries , Electrosurgery/adverse effects , Evaluation Studies as Topic , Hemorrhage/etiology , Humans , Intestinal Perforation/etiology , Length of Stay , Pancreatitis/etiology , Sphincter of Oddi/surgeryABSTRACT
Case report on two patients with massive hemorrhage from the pancreatic duct as proven by duodenoscopy and retrograde pancreatography. In patients with blood pouring from the orifice of the papilla of Vater retrograde ductography should be performed to prove hemobilia or hemosuccus pancreaticus.
Subject(s)
Cholangiography/methods , Endoscopy/methods , Gastrointestinal Hemorrhage/diagnosis , Pancreatic Diseases/diagnosis , Pancreatic Ducts , Adult , Ampulla of Vater , Duodenum , Humans , Male , Pancreatectomy , Pancreatic Cyst/diagnosis , Pancreatic Cyst/surgery , Pancreatic Fistula/diagnosis , Pancreatitis/diagnosis , Postoperative Complications/diagnosisSubject(s)
Endoscopy , Pancreas/abnormalities , Humans , Pancreas/diagnostic imaging , Pancreatitis/etiology , RadiographyABSTRACT
Experimental studies carried out in 11 dogs have shown that, with the aid of a high frequency diathermy probe, satisfactory papillotomies can be performed. On the basis of these results, endoscopic papillotomies have been carried out in 23 patients. Indications for papillotomy were biliary calculi in 11 high-risk patients, in 6 cases calculi overlooked during bile duct surgery, and in 3 patients recurrent calculi after previous cholecystectomy. In 3 patients circumscribed papillary stenosis indicated endoscopic papillotomy. Papillotomy was successful in all 23 cases. In 9 cases the calculi had been passed spontaneously after 3-5 days. In 10 patients the stones had to be extracted using the Dormia basket or a wire loop, and in one patient the stone had to be removed surgically. In one of these patients endoscopic papillotomy was followed by an attack of pancreatitis which subsided after 3 days. Further complications, in particular the occurrence of massive bleeding after papillotomy, were not observed.
