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Schmidt-Wilcke T, Leinisch E, Kämpfe N, Draganski B, Bogdahn U, May A. Morphometrische Bildgebung und chronischer Schmerz. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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252
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Jürgens T, Busch V, Jakob W, Schulte-Mattler W, Kaube H, May A. Funktionelle Konnektivität des trigeminalen und okzipitalen Systems. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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253
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May A, Draganski B, Busch V, Schuierer G, Bogdahn U, Gaser C. Lernbedingte transiente Strukturänderung im adulten Gehirn. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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254
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Draganski B, Lummel N, Moser T, Gänssbauer S, Haas F, May A. Strukturelle Veränderungen im Thalamus nach Amputation einer Extremität. AKTUELLE NEUROLOGIE 2004. [DOI: 10.1055/s-2004-833148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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255
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Meran JG, May A, Geissendörfer S, Simon A. Möglichkeiten und Grenzen von Patientenverfügungen. ONKOLOGE 2003. [DOI: 10.1007/s00761-003-0615-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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May A, Nachbar L, Wardak A, Yamamoto H, Ell C. Double-balloon enteroscopy: preliminary experience in patients with obscure gastrointestinal bleeding or chronic abdominal pain. Endoscopy 2003; 35:985-91. [PMID: 14648408 DOI: 10.1055/s-2003-44582] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS Even in the era of capsule endoscopy, diseases of the small bowel are sometimes difficult to diagnose, and endoscopic treatment is not possible without surgical laparotomy. The new method of carrying out enteroscopy using a double-balloon technique allows not only diagnostic but also therapeutic endoscopic interventions for lesions in the small bowel. Preliminary experience with this new method is reported here. PATIENTS AND METHODS Between the end of March 2003 and August 2003, eight patients (four women, four men; mean age 59 +/- 23 years, range 20 - 90) with chronic gastrointestinal bleeding or abdominal pain, or both, underwent enteroscopy using the double-balloon technique. Seven of the patients had been suffering from chronic gastrointestinal bleeding for 56 +/- 49 months (range 3 - 120 months, median 48 months). The lowest hemoglobin levels ranged from 3.6 g/dl to 8.6 g/dl (mean 6.7 +/- 1.7 g/dl), and a mean of 7.6 +/- 5.6 (range 1 - 15) blood units had been transfused. Capsule endoscopy was carried out in six patients, revealing angiodysplasias in three, suspected Crohn's disease in one, fresh blood in the small bowel without a lesion in one, and a focal enanthema in another patient. RESULTS Enteroscopy with the double-balloon technique was carried out using the oral approach in all patients and additionally with the anal approach in four patients. In two patients with multiple angiodysplasias, it was possible to examine the whole small bowel and to treat the angiodysplasias. All of the capsule endoscopy findings were confirmed; a definite bleeding source was found and treated in two patients with unclear bleeding, and in another patient the real bleeding source was found (not angiodysplasia). The enteroscopy system was easy to handle in all cases. No complications occurred. It was possible to carry out the procedure with the patients under sedoanalgesia. CONCLUSIONS This new enteroscopy system is easy to handle and seems to be safe. Visualization of the whole small bowel is possible using both the oral and anal approaches. Enteroscopy with the double-balloon technique promises to become a standard method for diagnostic and therapeutic endoscopy of the small bowel without surgical laparotomy.
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Holdcroft A, Konje JC, May A. Small babies and substandard anaesthesia: the Confidential Enquiries into Stillbirths and Deaths in Infancy 27/28 report. Int J Obstet Anesth 2003; 12:271-4. [PMID: 15321456 DOI: 10.1016/s0959-289x(03)00103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2003] [Indexed: 11/25/2022]
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258
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Abstract
Randomized placebo-controlled clinical trials have been the 'golden standard' during the last decades in the development of new drug therapies. This scientifically valid approach has recently been questioned in the fifth revised version of the Declaration of Helsinki, which states that the use of placebo-controlled clinical trials is only acceptable when no proven treatment exists for the studied disease. The World Medical Association further claims that no national ethical, legal or regulatory requirements should be allowed to reduce or eliminate any of the statements in the declaration. In spite of this, the document is not generally accepted as the world ethical standard, as demonstrated by its lack of adoption by many professional associations. In the evaluation process for a drug to be approved in many countries today, clinical investigators at the hospitals and researchers at the pharmaceutical companies are obliged to use study protocols that would be rejected if the new declaration were to be fully adopted. Adherence to the clinical trial guidelines of the International Headache Society could also mean violation of the new Helsinki declaration of ethics. Some ethics committees have already adopted the new declaration, which has caused concern among clinical investigators, who find this document to be vastly out of the line with common practice. At the moment, the situation is unclear and debated with increasing polarity concerning the scientific and ethical issues regarding the use of placebo in clinical trials.
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259
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Trebble TM, Wootton SA, May A, Erlewyn-Lajeunesse MDS, Chakraborty A, Mullee MA, Stroud MA, Beattie RM. Essential fatty acid status in paediatric Crohn's disease: relationship with disease activity and nutritional status. Aliment Pharmacol Ther 2003; 18:433-42. [PMID: 12940929 DOI: 10.1046/j.1365-2036.2003.01707.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Active paediatric Crohn's disease is associated with nutritional deficiencies and altered nutrient intake. The availability of essential fatty acids (linoleic and alpha-linolenic acids) or their derivatives (arachidonic and eicosapentaenoic acids) may alter in plasma and cell membrane phospholipid in protein-energy malnutrition in children and in Crohn's disease in adults. AIM To investigate the relationship of fatty acid phospholipid profiles with disease activity and nutritional status in paediatric Crohn's disease. METHODS The fatty acid (proportionate) composition of plasma and erythrocyte phosphatidylcholine was determined in 30 patients (10.3-17.0 years) stratified into active and quiescent Crohn's disease (paediatric Crohn's disease activity index) and high and low body mass (body mass index centile). RESULTS In plasma phosphatidylcholine, active disease activity was associated with a lower level of alpha-linolenic acid compared with that in quiescent disease (P < 0.05). A body mass index below the 50th centile was associated with active Crohn's disease, low linoleic and alpha-linolenic acids and high arachidonic acid (P < 0.05) in plasma phosphatidylcholine, and low alpha-linolenic acid in erythrocyte phosphatidylcholine. These findings could not be explained through differences in habitual dietary fat intake. CONCLUSION In paediatric Crohn's disease, a low body mass index centile and high disease activity are associated with altered profiles of essential fatty acids and their derivatives, which may reflect altered metabolic demand.
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260
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Straube A, May A, Haag G, Neu I, Evers S. [Migraine and tension headache. Are over the counter analgesics effective?]. MMW Fortschr Med 2003; 145:45-6. [PMID: 12619361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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261
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Faller G, Berndt R, Borchard F, Ell C, Fuchs KH, Geddert H, Gossner L, Günther T, Kirchner T, Koch HK, Langner C, Lüttges J, May A, Müller S, Oberhuber G, Seitz G, Stolte M, Tannapfel A, Vieth M, Walch A, Rüschoff J. [Histopathological diagnosis of Barrett's mucosa and associated neoplasias. Results of a consensus conference of the Working Group for "Gastroenterological Pathology of the German Society for Pathology" on 22 September 2001]. DER PATHOLOGE 2003; 24:9-14. [PMID: 12601473 DOI: 10.1007/s00292-002-0600-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There are a number of difficulties regarding the diagnosis of Barrett's mucosa and the varying grades of neoplasia that may be associated with it. It was therefore the aim of a consensus conference of the "Working Group for Gastroenterological Pathology within the German Society of Pathology" to achieve standardization regarding the following issues: definition and diagnostic criteria for Barrett's mucosa and its discrimination from intestinal metaplasia of the cardia, diagnostic criteria for intraepithelial neoplasia, number of biopsies necessary to establish the diagnosis, significance of additional immunohistochemical and/or molecular biological methods as well as importance of a second opinion in the diagnosis of intraepithelial neoplasia.
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Pech O, May A, Gossner L, Rabenstein T, Ell C. [Diagnosis and therapy of early neoplasia in Barrett's esophagus]. VERHANDLUNGEN DER DEUTSCHEN GESELLSCHAFT FUR PATHOLOGIE 2003; 87:137-41. [PMID: 16888905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
There has been a dramatic increase in recent years in the incidence of Barrett's esophagus and the esophageal adenocarcinoma associated with it. Adequate monitoring strategies and improved diagnostic procedures are therefore essential. Alongside conventional video endoscopy with four-quadrant biopsies, many additional diagnostic procedures are now available to improve monitoring. These allow early diagnosis of dysplastic areas and early carcinomas. Endoscopic therapy has gained more and more importance in the treatment of early esophageal neoplasias over the last few years. Localized lesions in the Barrett's segment should be treated by endoscopic resection (ER). Only in patients with not localized or multifocal superficial lesions photodynamic therapy (PDT) should be used. Between the different ER techniques the "suck and cut"-technique with ligation device or cap should be favoured to normal strip biopsy in the esophagus because of the size of the resected specimen and its technical feasibility. ER of high grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett's esophagus should be considered as the treatment of choice. ER of early neoplasia in Barrett's esophagus is a safe and effective method but should only be performed by experienced endoscopists.
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Matharu MS, Good CD, May A, Bahra A, Goadsby PJ. No change in the structure of the brain in migraine: a voxel-based morphometric study. Eur J Neurol 2003; 10:53-7. [PMID: 12534993 DOI: 10.1046/j.1468-1331.2003.00510.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Migraine is a common, disabling form of primary neurovascular headache. For most of the twentieth century it was regarded as a vascular headache whose primary pathophysiology lay in the cranial vasculature. Functional brain imaging using positron emission tomography has demonstrated activation of the rostral brain stem in acute migraine. Voxel-based morphometry is a new fully automated whole brain technique that is sensitive to subtle macroscopic and mesoscopic structural differences between groups of subjects. In this study 11 patients suffering from migraine with aura (10 females, one male: 23-52 years, mean 31); 11 controls (10 females, one male: 23-52, mean 31); 17 patients with migraine without aura (16 females, one male: 24-57, mean 34); 17 controls (16 females, one male: 24-57, mean 34) were imaged with high resolution volumetric magnetic resonance imaging. There was no significant difference in global grey or white matter volumes between either patients with migraine and controls, or patients with aura and without aura. This study did not show any global or regional macroscopic structural difference between patients with migraine and controls, with migraine sufferers taken as homogenous groups. If structural changes are to be found, other methods of phenotyping migraine, such as by genotype or perhaps treatment response, may be required to resolve completely whether there is some subtle structural change in the brain of patients with migraine.
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Paulus W, Evers S, May A, Steude U, Wolowski A, Pfaffenrath V. [Therapy and prophylaxis of facial neuralgias and other forms of facial pain syndromes -- revised recommendations of the German Society of Migraine and Headache]. Schmerz 2003; 17:74-91. [PMID: 12579391 DOI: 10.1007/s00482-002-0179-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Trigeminal neuralgia and postherpetic neuralgia are the most relevant neuralgiform facial pain syndromes. Trigeminal neuralgia is characterized by lancinating intensive pain attacks of very short duration, triggered by external cues,whereas postherpetic neuralgia consists predominantly of long-lasting burning pain. Sodium channel blocking drugs are first choice in treatment of trigeminal neuralgia, operative procedures encompass microvascular decompression,thermocoagulation and percutaneous retrogasserian glycerol rhizotomy. In the acute stage postherpetic neuralgia is treated antivirally and analgesically, in the chronic stage by tricyclic antidepressive substances. Other pain syndromes described encompass the Tolosa-Hunt-syndrome, cervicogenic headache, craniomandibular dysfunction syndrome, atypical facial pain and rarer syndromes. Therapeutic recommendations are based on evidence based medicine criteria (EBM).
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266
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Buch V, May A. Kopf- und Gesichtsschmerzen. THERAPEUTISCHE UMSCHAU 2003. [DOI: 10.1024/0040-5930.60.9.584e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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267
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Busch V, May A. [Trigemino-autonomic headache syndromes]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2003; 71:17-23. [PMID: 12529831 DOI: 10.1055/s-2003-36683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This review describes the characteristics of some rare severe primary headache syndromes without any structural lesions, which are summarized as the trigemino-autonomic headaches. Pain in these syndromes is associated with autonomic symptoms such as conjunctival injection, lacrimation, rhinorrhoe, ptosis or eyelid edema. This article summarizes the diagnostics, epidemiology and therapy of these conditions.
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Draganski B, Geisler P, Hajak G, Schuierer G, Bogdahn U, Winkler J, May A. Hypothalamic gray matter changes in narcoleptic patients. Nat Med 2002; 8:1186-8. [PMID: 12411926 DOI: 10.1038/nm1102-1186] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ell C, Remke S, May A, Helou L, Henrich R, Mayer G. The first prospective controlled trial comparing wireless capsule endoscopy with push enteroscopy in chronic gastrointestinal bleeding. Endoscopy 2002; 34:685-9. [PMID: 12195324 DOI: 10.1055/s-2002-33446] [Citation(s) in RCA: 401] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS In chronic gastrointestinal bleeding (CGB), bleeding sites located in the small bowel are difficult to detect with conventional radiological or scintigraphic techniques. Push enteroscopy (PE) is at present considered to be the most effective diagnostic procedure. The aim of this prospective trial was to compare the efficacy of wireless capsule endoscopy (CE) with PE. PATIENTS AND METHODS Between April and October 2001, 65 patients with CGB were referred to our unit. Complete conventional diagnostic work-up (including small-bowel enteroclysis, angiography, and scintigraphy), as well as PE and CE, were performed in 32 patients. RESULTS On average, the patients had been suffering from CGB for 29 +/- 24 months (6 - 126); the lowest hemoglobin level varied between 3.0 and 9.9 g/dl (mean 5.9 +/- 1.4); 17 +/- 18 blood units (0 - 60) were transfused. Each patient underwent 6 +/- 7 (range 1 - 38) hospitalizations, with a mean of 14 +/- 9 diagnostic procedures before CE was used. Conventional diagnostic procedures revealed relevant pathological findings in five of the 32 patients (16 %). Definite bleeding sites diagnosed by PE in nine patients (28 %) included angiodysplasia (seven patients), small-bowel cancer (one patient) and lymphoma (one patient). CE detected the definite source in 21 of the 32 patients (66 %) ( P < 0.001). Definite bleeding sources included angiodysplasia (17 patients), malignant stenoses (two patients) and inflammatory small-bowel disease (two patients). Questionable bleeding sources were seen on PE in three additional patients (9 %), and using CE in a further seven patients (22 %). Both CE and PE were safe and were not associated with any morbidity. CONCLUSIONS In the present trial in patients with CGB, wireless CE had the highest diagnostic yield and was significantly superior to PE. CE can help reduce the number of diagnostic procedures and could become the initial diagnostic choice in patients with CGB and negative upper and lower gastrointestinal endoscopy.
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May A, Gossner L, Pech O, Müller H, Vieth M, Stolte M, Ell C. Intraepithelial high-grade neoplasia and early adenocarcinoma in short-segment Barrett's esophagus (SSBE): curative treatment using local endoscopic treatment techniques. Endoscopy 2002; 34:604-10. [PMID: 12173079 DOI: 10.1055/s-2002-33236] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND STUDY AIMS In recent years, short-segment Barrett's esophagus (SSBE) has attracted increasing attention in the context of reflux disease. However, there is continuing controversy regarding its potential for malignant transformation. PATIENTS AND METHODS Between October 1996 and September 1999, 50/115 patients (43 %) with intraepithelial high-grade neoplasia or early Barrett's adenocarcinoma, who underwent local endoscopic treatment, had developed a malignant lesion in an (SSBE). In the framework of a prospective observational study, 28 patients were treated with endoscopic mucosal resection (EMR), 13 with photodynamic therapy, and three with argon plasma coagulation; six patients received combinations of these treatments. RESULTS Complete local remission was achieved in 48/49 patients (98 %). One patient switched to surgery after the first EMR, because there was submucosal tumor infiltration, and in one patient out of 50 local endoscopic treatment failed. A mean of 1.7 +/- 1.4 treatment sessions was required for local endoscopic treatment. The method-associated mortality was 0 %. The rate of relevant complications (stenosis, bleeding) was 6 % (3/50 patients). No cases of severe hemorrhage (Hb fall >2 g/dl) or perforation occurred. During a mean follow-up period of 34 +/- 10 months, metachronous intraepithelial high-grade neoplasms or early adenocarcinomas were seen in 11/48 patients (23 %), who received further successful endoscopic treatment. Four patients died during the follow-up period, but in only one patient was this due to his Barrett's adenocarcinoma (this was the patient who underwent esophageal resection). CONCLUSIONS The malignant potential of short-segment Barrett's esophagus must not be underestimated. Organ-preserving local endoscopic treatment shows good acute-phase and long-term results. Local endoscopic treatment represents an alternative to esophageal resection in the case of intraepithelial high-grade neoplasia and selected early adenocarcinomas in Barrett's esophagus.
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271
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Werk D, May A, Ell C. Früherkennung und lokale endoskopische Behandlung von Magenfrühkarzinomen. Visc Med 2002. [DOI: 10.1159/000064167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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272
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Pech O, Gossner L, May A, Ell C. Früherkennung, Diagnostik und endoskopische Therapie früher Neoplasien des Ösophagus. Visc Med 2002. [DOI: 10.1159/000064165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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273
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Pech O, May A, Gossner L, Mayer G, Abdollahnia R, Ell C. Endoscopic therapy for Zenkers's diverticulum by means of argon plasma coagulation. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2002; 40:517-20. [PMID: 12122600 DOI: 10.1055/s-2002-32798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We describe a 80-year-old man who presented with progressive dysphagia because of a Zenker's diverticulum. Barium swallow study revealed a large posterior diverticulum with a distal stenosis of the esophagus caused by compression. Because the patient was a poor candidate for surgery an endoscopic therapy was performed. The Zenker bridge was divided by argon plasma coagulation in two sessions without any complication to allow an overflow. The patient remained asymptomatic to date for a follow-up of 6 months.
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Emig G, May A, Scheidel P. Computer Simulation of the Performance of a Downer-Regenerator CFB for the Partial Oxidation of n-Butane to Maleic Anhydride. Chem Eng Technol 2002. [DOI: 10.1002/1521-4125(200206)25:6<627::aid-ceat627>3.0.co;2-h] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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275
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Gossner L, May A, Ell C. [Barrett esophagus--esophageal carcinoma: conservative therapy and observation]. PRAXIS 2002; 91:881-885. [PMID: 12071090 DOI: 10.1024/0369-8394.91.20.881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Chronic acid reflux is strongly associated with cancer of the esophagogastric junction and the main reason for the development of specialised intestinalised metaplasia in the esophagus (Barrett's esophagus). Endoscopic surveillance, therefore, is mandatory for long-segment Barrett's esophagus as well as short segment Barrett's. Videoendoscopy with four quadrant random biopsies are standard and new diagnostic tools like chromoendoscopy with methylene blue, magnifying endoscopy or fluorescence detection may turn out to be helpful. Differential surveillance strategies according to the recommendations of the American College of Gastroenterology and the Deutschen Gesellschaft für Verdauungs- und Stoffwechselerkrankungen should be performed for medical and cost-efficiency reasons. Local endoscopic therapy of early cancer and high-grade dysplasia in Barrett's esophagus comprises three different methods: endoscopic mucosal resection (EMR), semiselective, athermal photodynamic therapy (PDT) and thermal techniques such as KTP- or Nd:YAG-laser and argon-plasma coagulation. All endoscopic methods have low morbidity and mortality rates compared to esophageal resection and therefore are an attractive alternative treatment option. Endoscopic mucosal resection is the treatment of choice for all localizable and circumscribed lesions, because the resected specimen can be classified with regard to the histopathological grading, complete resection and submucosal involvement, especially in view of patients who are surgical candidates. PDT is the best local treatment option for multifocal, not localizable or large superficial lesions, as large areas can be treated in a single therapeutic session. Thermal procedure are mainly auxiliary methods for the optimization of EMR or PDT. The shortterm and intermediate results of our studies appear to be promising in view of the high complete local remission rates in combination with the low morbidity and mortality.
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