[Complications of endoscopic sclerotherapy of esophageal varices]. / Komplikationen der endoskopischen Sklerotherapie von Osophagusvarizen.

Within the framework of a retrospective study complications of endoscopic variceal sclerotherapy were analyzed. From April, 1, 1988 till August, 31, 1994 267 consecutive patients (158 male, 109 female, mean age 43 [27-78] years) with esophageal variceal hemorrhage due to liver cirrhosis and portal hypertension underwent endoscopic variceal injection treatment. Sclerotherapy was performed with 24.5 ml (12-34 ml) 1% of polydocanole on average per treatment. Each patient had 4.5 (2-7) therapy sessions on average. Local complications were: Transient dysphagia (73%), chest pain (65%), esophageal ulcerations (63%), ulerogenic bleeding (14%), posttherapeutic hemorrhage (13%), esophageal strictures (10%), pleural effusions (9%), subfebrile temperatures (6.4%), pericarditis (0.4%) and esophageal perforation (0.4%). No patient died from sclerotherapy-induced side effects. In conclusion, endoscopic injection therapy is an efficient treatment of acute variceal hemorrhage. Not severe local complications often occur, severe side effects are extremely rare, however.

[Proctoscopic Doppler ultrasound in diagnosis and therapy of symptomatic first degree hemorrhoids ]. / Die proktoskopische Dopplersonographie in Diagnostik und Therapie symptomatischer erstgradiger Hämorrhoiden.

Within the framework of a prospective study two comparable collectives with each 62 patients and symptomatic first grade hemorrhoidal disease were examined. Guiding symptom was painless hematochezia. The hemorrhoids of collective A were evaluated with the aid of transproctoscopic Doppler ultrasound. The depth of the vessels was determined and a Doppler located injection therapy was performed. The patients of collective B were only investigated by means of proctoscopy and sclerosed without Doppler. Sclerosing injection was carried out in all cases with 6 ml Phenylamygdalic oil by 3, 7 and 11 o'clock lithotomy position. Success of therapy was controlled in all patients 2 weeks later Doppler sonographically. In 87% of the Doppler controlled treated patients the hemorrhoids were completely eliminated and no more arterial blood flow could be scanned. On the contrary only 37% of the initially not Doppler scanned patients were cured. Endoscopic Doppler ultrasound is and effective method in evaluation and treatment of symptomatic first grade hemorrhoids.

[Stent implantation in post-stenotic retention pneumonia caused by inoperable bronchial carcinoma]. / Stent-Implantation bei poststenotischer Retentionspneumonie wegen inoperablem Bronchialkarzinom.

The 65 year old patient referred to in this report has been suffering from an inoperable squamous cell carcinoma of the right superior lobe of the lung for the last two years. After therapeutic irradiation the disease subsided temporarily. Subsequently the patient became severely ill and was referred to hospital with high fever and refractory pneumonia. X-ray film revealed atelectasis of the right superior and central lobes and a pneumonic infiltration of the right inferior lobe. Bronchoscopy showed complete tumour stenoses of the superior and central lobes. The lower lobe of the lung was visualised as subtotally stenosed and obstructed by pus. Despite pathogen-directed antibiosis the poststenotic retention pneumonia did not heal. After laser recanalisation of the right inferior lobe we implanted an endobronchial stent. Subsequently, the pneumonia receded and the patient survived for five months relatively free from complaints.

[Metastatic echinococcosis as a rare differential diagnosis of therapy refractory bronchitis]. / Organüberschreitende Echinokokkose als seltene Differentialdiagnose einer therapieresistenten Bronchitis.

In a 68 year old male german patient we found a transdiaphragmatic perforation of a superinfected liver echinococcus granulosus cyst into the bronchial system as cause of a purulent bronchitis resistant to treatment. After operative removal and oversewing of diaphragm bronchitis was cured and the patient could be discharged.