Tilman Sauerbruch

Shock-wave therapy of gastric outlet syndrome caused by a gallstone

A patient with gastric outlet syndrome (Bouverets syndrome) caused by a large gallstone impacted in the duodenal bulb was successfully treated by extracorporeal shock-wave lithotripsy. Thus, open abdominal surgery could be avoided. For disintegration of the stone, three consecutive lithotripsy procedures were necessary. Thereafter, stone fragments could be extracted endoscopically. Extracorporeal shock-wave lithotripsy could become a non-surgical alternative in patients with obstruction of the duodenum caused by a gallstone.

Characterization of the ANF system in patients with cirrhosis of the liver

Defects of the ANF system in cirrhosis could not be demonstrated in terms of an absolute deficiency of plasma levels or evidently major abnormalities of processing in patients with cirrhosis. In the present study the responsiveness of the ANF system to acute volume stimulation by water immersion, the diuretic and natriuretic effects of ANF infusion were examined. Stimulation of ANF release by 1 h immersion was significantly blunted in 10 cirrhotic patients with ascites (increase of plasma ANF by 46 ± 18%), whereas 11 cirrhotics without ascites showed a 104 ± 16% increase, similar to the 117 ± 29% stimulation in 25 healthy controls. Immersion increased urinary volume by 3.6 ± 0.6, 2.0 ± 0.8, and 0.7 ± 0.4 ml/min, and urinary sodium excretion by 146 ± 38, 75 ± 43, and 43 ± 19 μmol/min in controls, cirrhotics without ascites, and cirrhotics with ascites, respectively. Infusion of ANF for 30 min prompted an increase in diuresis and natriuresis in seven cirrhotic patients, which was less marked in patients with ascites as compared to patients without. Thus, the stimulus-response coupling for ANF may be impaired in patients with cirrhosis and ascites.

Prophylaxis of first variceal hemorrhage in patients with liver cirrhosis

SummaryProphylaxis of bleeding from esophageal varices is a very tempting concept at first glance, especially under the assumption of a high mortality associated with first variceal hemorrhage. Up to now four different measures have been tried for prophylaxis: portacaval shunt operation, devascularization procedures, sclerotherapy, and drugs. With the exception of portacaval shunts, ongoing controlled trials show a weak trend toward reduction of variceal bleeding and prolongation of survival in selected patients with compensated cirrhosis and large varices. However, prophylaxis of first variceal bleeding must still be regarded as experimental and should be restricted to controlled clinical studies.