37. Endoskopie in Diagnostik und Therapie

Zusammenfassung Laparoskopie und laparoskopische Cholangiographie haben zur Klärung des Verschlußikterus ihren Beitrag geleistet, wurden jedoch durch ERCP verdrängt. Heute sollte, wenn möglich, kein Verschlußikterus ohne vorherige ERCP operiert werden. Die EST gilt als Methode der Wahl beim Rezidivstein des cholecystektomierten, über 60jährigen Patienten sowie beim Residualstein des Frischoperierten. Die Techniken der transpapillären biliären Drainage mit innerer oder äußerer Ableitung zur palliativen Tumortherapie oder Litholyse haben das Spektrum der endoskopischen Chirurgie beträchtlich erweitert.     

Scanning electron microscopic study of the cat papilla neglecta

Summary The papilla neglecta in the cat vestibule was studied under a scanning electron microscope. This papilla appears as a small mound of cells on the utricle near the posterior semicircular canal crista. The number of sensory hair bundles on the papilla ranged from 11–64 in 7 ears examined (average, 37). Although this crista-like endorgan was regularly found in the cat, its function may not be important in that the number of sensory hair cells is only 1/150 of those counted on guinea pig posterior semicircular canal crista.This study was partly supported by U.S.P.H.S. Research Grant No. NS 10412-03The authors are deeply indebted to Professor Jun-Ichi Suzuki (Teikyo University) for his encouragement in this study. Mr. Dominic W. Hughes kindly helped in English compilation.     

Reliable ductal access in sialoendoscopy

During sialoendoscopy, insertion of the endoscope through the ductal orifice is usually a challenging procedure, especially for beginners. Based on our experience, we have found that using the Kolenda Salivary Access Introducer Set is the most reliable and easily learned ductal access approach. We report details of the technique and discuss the advantages of this approach.     

Human pancreatic polypeptide (HPP) immunoreactivity in an infiltrating endocrine tumour of the papilla of vater with unusual morphology

Summary Histological, histochemical and clinical features of an endocrine duodenal tumour situated in the papillary region were studied. The tumour had a remarkable mixed histological growth pattern, consisting of epithelial glandular structures which showed a gradual transition into a spindle-cell tumour, resembling a neurogenic tumour. The neoplasm was considered malignant since it had infiltrated into the muscular layer of the duodenal wall.The tumour was non-argentaffin and non-argyrophil. No serotonin could be demonstrated histochemically. Immunoreactive pancreatic polypeptide (HPP) was detected by indirect immunofluorescence in the majority of tumour cells of the epithelial glandular structures, whereas areas with a spindlecell pattern were almost unreactive to the HPP-antiserum. No reaction was found with antibodies against gastrin, insulin, glucagon, vasoactive intestinal polypeptide or somatostatin.The patient had no endocrine symptoms that could be ascribed to the production of HPP by the neoplasm. Twenty-four months postoperatively, the patient's serum HPP concentration had begun to rise, suggesting recurrence of the tumour.The authors thank Mrs Leni Grubb for excellent technical assistance. This work was supported by grants from the Swedish Research Council (project No.12X-718)     

Developmental stage-specific involvement of angiotensin in murine nephrogenesis

Angiotensinogen-deleted mice (Agt-KO) show phenotypes of hypotension and renal atrophy. To investigate whether an alternative pathway other than angiotensin II (AII), i.e., processed angiotensin fragments, may play a biological role in nephrogenesis, we analyzed a congenic line of Agt-KO fetuses and neonates derived from two sources: one (Agt-KO/He) from mating with heterozygous angiotensinogen-deleted mice and the other (Agt-KO/Ho) from mating homozygous angiotensinogen-deleted mice. Although Agt-KO/He did not show a typical phenotype at birth, these mice showed papillary atrophy 2 weeks later and thereafter, a marked increase in renal size, i.e., pelvic dilatation. In contrast, Agt-KO/Ho showed renal abnormalities at birth and subsequently died. TUNEL staining and electron microscopy revealed that accelerated papillary apoptosis was present at birth in Agt-KO/Ho and caused abnormal papillary development; however, apoptosis was not detected in Agt-KO/He, suggesting that different mechanisms for the abnormal renal development exist in Agt-KO/He and Agt-KO/Ho. Two-week administration of an angiotensin fragment (3–8), angiotensin IV (AIV), to Agt-KO/He markedly attenuated the renal atrophy, decreasing the incidence from 81% to 14%. However, administration of AIV to fetal Agt-KO/Ho through the mother did not decrease the incidence. This is marked contrast to AII, which prevented renal atrophy in both fetal and neonatal periods. It is therefore suggested that AIV is involved in nephrogenesis in a developmental stage-specific manner. Received: 2 September 1998 / Revised: 22 December 1998 / Accepted: 1 February 1999     

Optimal endoscopic techniques to reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis

Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common and feared complication of endoscopic retrograde cholangiopancreatography. Patient selection is an important variable that is important when determining the risk of PEP. The factors that may increase the risk of PEP include papillary trauma, papillary edema, and pancreatic ductal injury (mechanical or hydrostatic). Proven methods to decrease the risk of PEP include wire-guided cannulation, prophylactic short-term pancreatic duct (PD) stenting, and avoiding frequent PD cannulation, injection, or overinjection. Additional measures that might decrease the risk of PEP by decreasing cannulation time include a double guidewire technique, and early precut sphincterotomy. Certain techniques are known to have an increased risk of pancreatitis and should be implemented only when necessary. When performing measures such as large-balloon papillary dilation or pancreatic sphincterotomy, the rates of pancreatitis may be decreased with small alterations in the technique. A short biliary sphincterotomy when performed with papillary large-balloon dilation and needle-knife pancreatic sphincterotomy over a PD stent have both been shown to decrease the risk of pancreatitis.     

应用抑制性消减杂交技术筛选和克隆斑秃脱发相关基因

目的 筛选和克隆斑秃脱发相关基因。方法 分别分离斑秃脱发区和非脱发区毛乳头后,应用抑制性消减杂交比较脱发区和非脱发区毛乳头基因表达的差异,对脱发区毛乳头特异表达的基因进行克隆、测序和同源性分析。结果 建立了斑秃脱发区毛乳头cDNA消减文库,并成功地克隆到一条斑秃毛乳头特异表达的基因片段,同源性检索证实其为一条自身抗原基因。结论 所建立的消减文库可能含有斑秃发病相关基因,所克隆的到自身抗原基因在斑秃发病中的作用值得进一步研究。     

引导骨再生术对美学区种植体周软组织的影响

目的引导骨再生(guided bone regeneration,GBR)技术是解决种植体周围骨损伤缺的有效方法,文中通过临床回顾性研究,评价GBR术同期牙种植对美学区种植体周软组织的影响。方法选取45名患者共60颗(其中基于GBR后种植30颗,常规种植30颗)负重1年的种植体进行临床病历回顾,在术后的3个时间点(种植体暴露口腔后1个月为T1,完成永久修复体之后为T2,以及功能负荷1年后为T3,分别记录了各组种植体的牙周探诊深度和龈乳头指数,分析行GBR术对前牙种植的牙周指数有无影响。结果对比3个时间点2组临床资料牙周探诊指数的变化,GBR组:T1(2.11±0.68)mm,T2(2.13±0.70)mm,T3(2.31±0.84)mm;常规种植组:T1(2.08±0.71)mm,T2(2.15±0.70)mm,T3(2.27±0.84)mm,2组间差异无统计学意义(P>0.05)。龈乳头指数的2组频数分布差异也无统计学意义(P>0.05)。结论 GBR术对美学区牙种植体周牙龈未发现明显影响。