A Stier

HELIOS Klinikum Erfurt, Erfurt, Thuringia, Germany

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Publications (18)32.6 Total impact

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    ABSTRACT: Background/Aims: To develop a clinically relevant immunocompetent murine model to study pancreatic cancer using two different syngeneic pancreatic cancer cell lines and to assess MRI for its applicability in this model. Methods: Two cell lines, 6606PDA and Panc02, were employed for the experiments. Cell proliferation and migration were monitored in vitro. Matrigel™ was tested for its role in tumor induction. Tumor cell growth was assessed after orthotopic injection of tumor cells into the pancreatic head of C57/BL6 mice by MRI and histology. Results: Proliferation and migration of Panc02 were significantly faster than those of 6606PDA. Matrigel did not affect tumor growth/migration but prevented tumor cell spread after injection thus avoiding undesired peritoneal tumor growth. MRI could reliably monitor longitudinal tumor growth in both cell lines: Panc02 had a more irregular finger-like growth, and 6606PDA grew more spherically. Both tumors showed local invasiveness. Histologically, Panc02 showed a sarcoma-like undifferentiated growth pattern, whereas 6606PDA displayed a moderately differentiated glandular tumor growth. Panc02 mice had a significantly shorter (28 days) survival than 6606PDA mice (50 days). Conclusion: This model closely mimics human pancreatic cancer. MRI was invaluable for longitudinal monitoring of tumor growth thus reducing the number of mice required. Employing two different cell lines, this model can be used for various treatment and imaging studies.
    European Surgical Research 01/2011; 47(2):98-107. · 0.75 Impact Factor
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    ABSTRACT: We report a 47-year-old women who presented to her general practitioner and our hospital with weight loss of unknown etiology. Eight years previously she had undergone a hemithyroidectomy for nodular goiter with one cold nodule. Laboratory results revealed hypercalcemia, evidence of primary hyperparathyroidism and computer tomography of the thorax showed bilateral pulmonary metastasis. After undergoing CT-guided biopsy of a metastasis, histology revealed an endocrine primary tumor with low parathyroid hormone expression. In view of the history, clinical and biochemical findings we diagnosed a recently metastasized functioning parathyroid carcinoma, which eight years previously has been labeled as a benign atypical thyroid adenoma. The patient underwent surgical resection of all detected metastases. Afterwards the serum calcium and parathyroid hormone levels normalized. Parathyroid carcinoma is an uncommon tumor. In the absence of pathognomonic diagnostic criteria a definitive pathological diagnosis of parathyroid carcinoma often is not possible. The treatment of parathyroid carcinoma is essentially surgical. Patients with parathyroid carcinoma mostly die from uncontrollable hypercalcemia rather than from other tumor-related complications.
    Der Internist 03/2009; 50(3):361-7. · 0.33 Impact Factor
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    ABSTRACT: Eine 47-jährige Patientin begab sich wegen eines Gewichtsverlusts in ambulante und stationäre Diagnostik. 8Jahre zuvor war eine subtotale Schilddrüsenresektion rechts bei szintigraphisch kaltem solitärem Schilddrüsenknoten erfolgt. Computertomographisch fielen metastasenverdächtige intrapulmonale Rundherde beidseits, laboranalytisch eine Hyperkalzämie und ein primärer Hyperparathyreoidismus auf. Die CT-gestützte Punktion eines Lungenrundherds diagnostizierte histologisch die Metastase eines Primärtumors des endokrinen Systems. Infolge der histologisch schwachen Expression von Parathormon (PTH), der wegweisenden Klinik und Laboranalytik stellten wir die Diagnose eines metastasierten hormonaktiven Nebenschilddrüsenkarzinoms, das 8Jahre zuvor histologisch als Schilddrüsenadenom imponierte. Nach der chirurgischen Resektion aller gesicherten Metastasen normalisierten sich Serumkalzium und PTH. Das Nebenschilddrüsenkarzinom ist ein seltener Tumor, zu dem keine spezifischen histologischen Kriterien existieren. Die Diagnose wird oft verzögert gestellt, da Charakteristika für einen malignen Tumor zum Zeitpunkt der Operation nicht vorliegen oder erkannt werden. Therapeutisch erfolgt ein radikales operatives Vorgehen. Die schweren Hyperkalzämien sind ursächlich für die Morbidität und Letalität der Erkrankung. We report a 47-year-old women who presented to her general practitioner and our hospital with weight loss of unknown etiology. Eight years previously she had undergone a hemithyroidectomy for nodular goiter with one cold nodule. Laboratory results revealed hypercalcemia, evidence of primary hyperparathyroidism and computer tomography of the thorax showed bilateral pulmonary metastasis. After undergoing CT-guided biopsy of a metastasis, histology revealed an endocrine primary tumor with low parathyroid hormone expression. In view of the history, clinical and biochemical findings we diagnosed a recently metastasized functioning parathyroid carcinoma, which eight years previously has been labeled as a benign atypical thyroid adenoma. The patient underwent surgical resection of all detected metastases. Afterwards the serum calcium and parathyroid hormone levels normalized. Parathyroid carcinoma is an uncommon tumor. In the absence of pathognomonic diagnostic criteria a definitive pathological diagnosis of parathyroid carcinoma often is not possible. The treatment of parathyroid carcinoma is essentially surgical. Patients with parathyroid carcinoma mostly die from uncontrollable hypercalcemia rather than from other tumor-related complications.
    Der Internist 02/2009; 50(3):361-367. · 0.33 Impact Factor
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    ABSTRACT: Ist bei einem blutenden Ulcus duodeni eine primäre endoskopische Blutstillung nicht erreichbar oder kommt es zu einer Rezidivblutung, ist die operative Therapie der Standard. Eine atypische Gefäßversorgung kann dabei zur Rezidivblutung führen. Dann ist eine Angiographie mit Intervention zielführend. Im Folgenden wird über einen Patienten mit einer seltenen atypischen arteriellen Gefäßverbindung zwischen dem Truncus coeliacus und der A.gastroduodenalis, die zu Rezidivblutungen aus einem Ulcus duodeni führte, berichtet. Hemorrhagic duodenal ulcers should primarily be controlled by endoscopy. In cases of recurrent bleeding or if bleeding cannot be controlled endoscopically, open surgery is the gold standard. Rarely, atypical origin of arteries or additional atypical arteries may lead to further unexpected hemorrhagic recurrences and angiography with surgical intervention is the treatment of choice. In this article a rare case of an atypical visceral artery connecting the coeliac trunk and the gastroduodenal artery leading to recurrent bleeding from a duodenal ulcer is presented.
    Der Chirurg 02/2009; 80(3):238-240. · 0.52 Impact Factor
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    ABSTRACT: Hemorrhagic duodenal ulcers should primarily be controlled by endoscopy. In cases of recurrent bleeding or if bleeding cannot be controlled endoscopically, open surgery is the gold standard. Rarely, atypical origin of arteries or additional atypical arteries may lead to further unexpected hemorrhagic recurrences and angiography with surgical intervention is the treatment of choice. In this article a rare case of an atypical visceral artery connecting the coeliac trunk and the gastroduodenal artery leading to recurrent bleeding from a duodenal ulcer is presented.
    Der Chirurg 10/2008; 80(3):238-40. · 0.52 Impact Factor
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    ABSTRACT: To investigate whether laser-induced thermotherapy (LITT) for tumors of the liver in central location is a sufficient and safe therapeutic option. According to predefined criteria, 23 of 136 patients were chosen to be treated with LITT because of malignant liver tumors. At the time of the first LITT, the patients had 28 central tumors (27 metastases, one HCC), which were treated in 34 sessions with 64 laser applications and had a clinical and imaging follow-up every 3 months. The primary effectiveness rate was 74.1% and the secondary effectiveness rate 82.1%. The mortality rate was 0%. Major complications occurred in one patient (hemorrhagic pleural effusion), while minor complications occurred in 10 patients. During the median follow-up of 20 months (range 3-57 months), local tumor progression developed in 22% of the tumors. The effectiveness rate was 78.6%, 71.4% and 64.3% after 3, 6 and 9 months. The median survival was 46.0 months (95% confidence interval: 28.6-47.1 months). In our patients, complications and ablation rate of laser-induced thermotherapy for central liver tumors do not differ from those in peripheral location as described in the literature.
    RöFo - Fortschritte auf dem Gebiet der R 10/2005; 177(9):1267-75. · 2.76 Impact Factor
  • Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren - ROFO-FORTSCHR RONTGENSTRAHL. 01/2005; 177(09):1267-1275.
  • A Stier, C-D Heidecke
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    ABSTRACT: Due to the absence of established guidelines for the surgical treatment of lung metastases, informational prognostic factors such as: initial primary tumor, length of disease-free interval and number of lung metastases, can be derived from extensive, retrospective patient analyses and thereby serve as a directive in the development of a therapeutic course of treatment. The ultimate surgical goal is a complete, yet, parenchymal-sparing tumor resection. Regardless of primary tumor type, the 5-year survival rate for resected patients varies between 26 and 53%. Controversy still remains as to whether lung metastases should be removed either via open thoracotomy, or under video thoracoscopic conditions. Independent of surgical approach, thoracic surgical operations are associated with very low rates of morbidity as well as mortality even in patients of advanced age.
    Der Radiologe 08/2004; 44(7):715-8. · 0.47 Impact Factor
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    ABSTRACT: Chronic pancreatitis is characterized by periodic episodes of inflammation and loss of exocrine and endocrine function of the pancreas. Hereditary pancreatitis is an autosomal dominant disorder with an 80% penetrance, is associated with recurrent episodes of pancreatitis starting in early childhood and correlated to an increased risk of pancreatic cancer. The pathogenesis of chronic and hereditary pancreatitis is not yet fully understood. Patients suffering from chronic pancreatitis present with belt-like abdominal pain, weight loss, and often diabetes mellitus. The diagnosis is made by a combination of imaging procedures such as ultrasound and endoscopic retrograde cholangiopancreatography and exocrine and endocrine function tests. Therapy is restricted to symptom control. Approximately 30-60% of all patients develop disease-associated complications such as persistent pain, strictures of the common bile duct, or pancreatic duct stones which require either interventional or surgical treatment.
    Der Chirurg 08/2004; 75(7):731-47; quiz 748. · 0.52 Impact Factor
  • A. Stier, C.-D. Heidecke
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    ABSTRACT: Fr die chirurgische Therapie von Lungenmetastasen bestehen noch keine etablierten Leitlinien. Aus umfangreichen retrospektiven Patientenanalysen lassen sich jedoch Prognosefaktoren ableiten, die einer Therapieentscheidung zugrunde gelegt werden sollten. Das sind im Wesentlichen der ursprngliche Primrtumor, die Dauer des krankheitsfreien Intervalls und die Anzahl der Lungenmetastasen. Oberstes chirurgisches Therapieziel ist die vollstndige, aber mglichst parenchymsparende Tumorresektion. Die Fnfjahresberlebensrate resezierter Patienten liegt unabhngig vom Primrtumor zwischen 35 und 48%. Umstritten ist nach wie vor, ob Lungenmetastasen ber eine offene Thorakotomie oder unter videothorakoskopischen Bedingungen entfernt werden knnen. Unabhngig von der Verfahrenswahl sind thoraxchirurgische Eingriffe—auch im fortgeschrittenen Patientenalter—mit einer sehr geringen Morbiditt und Mortalitt durchfhrbar.Due to the absence of established guidelines for the surgical treatment of lung metastases, informational prognostic factors such as: initial primary tumor, length of disease-free interval and number of lung metastases, can be derived from extensive, retrospective patient analyses and thereby serve as a directive in the development of a therapeutic course of treatment. The ultimate surgical goal is a complete, yet, parenchymal-sparing tumor resection. Regardless of primary tumor type, the 5-year survival rate for resected patients varies between 26 and 53%. Controversy still remains as to whether lung metastases should be removed either via open thoracotomy, or under video thoracoscopic conditions. Independent of surgical approach, thoracic surgical operations are associated with very low rates of morbidity as well as mortality even in patients of advanced age.
    Der Radiologe 06/2004; 44(7):715-718. · 0.47 Impact Factor
  • Albrecht W Stier, H J Stein, M Schwaiger, C D Heidecke
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    ABSTRACT: Peristaltic forces cause a topographic, time-dependent distribution of bolus mass during its esophageal transport. A two-dimensional spatial-temporal pattern (profile) of local transit times is constructed by computer-based double compression of scintigraphic images sampled from whole swallows. Reconstruction by Gaussian bands and modeling this pattern discloses transient ellipsoidal bolus structures. The structures studied in 10 healthy volunteers present highly reproducible quantitative parameters for marking a region-specificity of transit times, which is related to the known region-selectivity of esophageal functions. Correlation of bolus flow with the dynamics of peristalsis is essential for understanding the complex mechanisms of esophageal transport as well as for diagnostic discrimination of disturbances of bolus flow.
    Diseases of the Esophagus 02/2004; 17(1):51-7. · 1.64 Impact Factor
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    ABSTRACT: Die chronische Pankreatitis ist definiert durch eine schubweise verlaufende Entzndung mit Verlust der exokrinen und endokrinen Funktion des Pankreas. Die hereditre Pankreatitis ist eine autosomal dominant vererbbare Form der chronischen Pankreatitis mit einer phnotypischen Penetranz von bis zu 80%. Sie ist durch rezidivierende Pankreatitisschbe, die meist im frhen Kindesalter beginnen, eine meist positive Familienanamnese, eine weitgehend gleiche Geschlechtsverteilung sowie das Fehlen anderer krankheitsassoziierter Risikofaktoren charakterisiert. Die Pathogenese der chronischen Pankreatitis ist in vielen Punkten noch unklar. Als Leitsymptom imponieren der grtelfrmige Oberbauchschmerz, Gewichtsverlust und Diabetes mellitus. Die Diagnose wird durch bildgebende Verfahren wie den transabdominellen Ultraschall und die ERCP sowie die Untersuchung der Pankreasfunktion gestellt. Die Therapie beschrnkt sich auf die Symptombekmpfung. Etwa 30–60% der Patienten entwickeln Komplikationen wie persistierende Schmerzen, Strikturen des Ductus hepatocholedochus, Pankreaspseudozysten oder Pankreasgangsteine, die einer interventionellen oder operativ-chirurgischen Therapie bedrfen.Chronic pancreatitis is characterized by periodic episodes of inflammation and loss of exocrine and endocrine function of the pancreas. Hereditary pancreatitis is an autosomal dominant disorder with an 80% penetrance, is associated with recurrent episodes of pancreatitis starting in early childhood and correlated to an increased risk of pancreatic cancer. The pathogenesis of chronic and hereditary pancreatitis is not yet fully understood. Patients suffering from chronic pancreatitis present with belt-like abdominal pain, weight loss, and often diabetes mellitus. The diagnosis is made by a combination of imaging procedures such as ultrasound and endoscopic retrograde cholangiopancreatography and exocrine and endocrine function tests. Therapy is restricted to symptom control. Approximately 30–60% of all patients develop disease-associated complications such as persistent pain, strictures of the common bile duct, or pancreatic duct stones which require either interventional or surgical treatment.
    Der Chirurg 01/2004; 75(7):731-748. · 0.52 Impact Factor
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    ABSTRACT: Subtotal esophagectomy still is the major treatment for early Barrett's carcinoma. The inevitable loss of the gastric reservoir leaves an unresolved functional problem. Distal esophageal resection combined with a short jejunal interposition might be a safe alternative with the advantage of better functional results. In this series, 12 or more months after limited surgery for early Barrett's carcinoma 8 patients underwent functional investigation by alimentary scintigraphy. The activity of a technetium-labeled bolus passing through the esophagus and the jejunal interposition into the stomach was consecutively measured. Compared to 11 healthy controls the transit through the tubular esophagus showed no significant delay; transit time, however, increased with a bolus-induced dilation of the jejunal interposition. The length of the transit time through the jejunal interposition correlated with the length of the jejunal segment. The delay of bolus passage into the stomach did not result in substantial symptoms in jejunal segments shorter than 12 cm. Propulsive activity within the jejunal interposition resulted in a bolus transport into the stomach without any reflux to the esophagus. These data demonstrate good transport function and reflux prevention of short jejunal segments interposed between the esophagus and the stomach.
    World Journal of Surgery 10/2003; 27(9):1047-51. · 2.23 Impact Factor
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    ABSTRACT: Depending on the origin of the tumor tissue, gastric tumors may be more or less accessible for biopsy diagnostics. However, especially submucous tumors present a diagnostic problem. Entity and dignity may remain unclear particularly in larger tumors and may not be clarified before operative excision via gastrotomy and frozen section diagnostics. Similar problems may occur in the diagnostics of epithelial tumors, if a reliable appraisal of the dignity based on forceps biopsy is impossible. To clarify their entity and dignity, tumors can be completely extirpated with minimally invasive techniques. Apart from the endoscopic mucosa resection (EMR), laparoscopic intragastric tumor resection and laparoscopic wedge resection were performed, especially in larger tumors. In the period from December 1999 to December 2001, we saw an indication for minimally invasive procedures in 22 patients. There were 5 cases of submucous tumors of unclear entity and 17 epithelial lesions. The epithelial lesions included 12 patients with tumors of unclear dignity and five cases with early gastric carcinomas. The EMR was performed without complications in all 14 cases. One of the three cases with wedge resection was followed by a gastrectomy for oncological reasons. One early postoperative bleeding occurred, which was controlled laparoscopically. Conversion to open surgery due to technical problems was necessary in two cases of laparoscopic intragastric resection, and in one case a gastrectomy was required for oncological intention. Beside the diagnostic aspect, the mentioned techniques also enable a minimally invasive therapy of locally excisable gastric tumors. In addition to benign and low grade malignant lesions, early gastric carcinomas of the intestinal type present an indication.
    Zentralblatt für Chirurgie 08/2003; 128(7):566-72. · 0.69 Impact Factor
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    ABSTRACT: A thin-caliber applicator system was developed for introducing a laser fiber under CT guidance into lung metastases with only minimal complications. A space-saving 5.5 French Teflon cannula with a titanium trocar and connectors for a laser light guide (2 or 3 cm Dornier Diffusor-Tip H-6111-T2 or H-6111-T3 coupled to a Dornier Medilas Fibertom 5100 laser, wavelength of 1064 nm) and a perfusion line for physiologic saline solution were developed. After puncture the laser Diffusor-Tip remains in the cannula and is cooled during its tissue passage by slowly flowing saline solution. The miniaturized applicator system (Monocath) was calibrated in nonperfused bovine liver for maximum energy supply and necessary flow of the cooling saline solution in reference to a commercially available 9 French laser catheter with an 11.5 French inducer sheath (Power-Applicator). The new applicator system was used for treating lung metastases in 10 patients over a period of 21 months. The size of heat coagulation in bovine liver was 24 +/- 2 ml using the miniaturized system with application of 15 W for 20 min and a saline flow of 0.75 ml/min, in comparison to a size of 29 +/- 7 ml for the commercial applicator (30 W, 20 min, 60 ml/min). All metastases could be safely approached with the miniaturized applicator, except for two metastatic lesions at the lung base in two patients. A minor pneumothorax developed in three patients and intrapulmonary bleeding in two. Contrast-enhanced CT demonstrated necrosis of the treated metastatic areas in 6 patients. Follow-up of three patients after 5, 6, and 8 months showed complete tumor regression with minimal scarring in one patient. The miniaturized applicator system enables the introduction of a laser fiber into pulmonary metastases with only minor complications. Complete ablation seems to be achievable in suitable patients with the applied laser energy and a slow cooling fluid flow rate.
    RöFo - Fortschritte auf dem Gebiet der R 04/2003; 175(3):393-400. · 2.76 Impact Factor
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    ABSTRACT: In Barrett's patients, functional disorders of oesophageal motility are currently measured by oesophageal manometry. Yet abnormalities of oesophageal volume transport in the critical regions of the upper oesophageal sphincter (UOS) and lower oesophageal sphincter (LOS) cannot be determined using these methods. To further characterise the activity of the sphincter regions, we developed a quantitative method for differentiation of oesophageal volume transport in Barrett's patients and healthy controls. We used a new technique of processing scintigraphic images, with data analysis based on a new concept of relative local transit time. Twelve patients with Barrett's oesophagus and 11 healthy volunteers were examined using alimentary scintigraphy after a semisolid test meal in a multiple swallow test. In individual scintigraphic images of five swallows we studied: (1) overall oesophageal clearance and (2) the topographic profile of the relative local transit time obtained by image conversion to a two dimensional line graph. This profile was reconstructed by assembling constituent Gauss bands, allocating their integrals to five oesophageal regions according to their band position. (1) Overall oesophageal clearance was not significantly different between the two groups. (2) In comparison with healthy volunteers, relative regional transit times of all 12 Barrett's patients were significantly increased in the hypopharyngeal region and decreased in the region of the distal oesophagus. The extent of the decrease in the region of the distal oesophagus showed a close correlation with the length of Barrett's metaplasia. Improvement in image processing allows alimentary scintigraphy to describe different regional patterns of oesophageal volume transport. Local oesophageal bolus transit is markedly abnormal in Barrett's patients without alteration in clearance. The presence of metaplasia itself implies a negative impact on both sphincter functions. These findings substantiate the diagnostic value of refined oesophageal scintigraphy.
    Gut 03/2002; 50(2):159-64. · 10.73 Impact Factor
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    ABSTRACT: In patients with achalasia, intrasphincteric injection of botulinum toxin (BTX) has been suggested as an alternative regimen to balloon dilation and has been shown to be superior to placebo injection. The aim of the present study was to test the effectiveness, the long-term outcome and the cumulative costs of BTX injection in consecutive patients with symptomatic achalasia in comparison with pneumatic balloon dilation. 37 patients, who presented with symptomatic achalasia between January 1994 and December 1996 were treated with either BTX injection (n = 23) or pneumatic dilation (n = 14). Patients with short-term or long-term symptomatic failures of the initial procedure were treated again, either with the same or with the alternative method, depending on the initial response and on the patient's wish. Symptoms were assessed using a global symptom score (0 - 10) which was evaluated before treatment and 1 week, 1 month and then every 6 months after the treatment. In addition, body weight and recurrence of symptoms were noted and manometry was carried out before and after treatment. The patients were regularly contacted for the long-term follow-up. There were significant improvements in the global symptom scores of all patients treated, in both the BTX injection group (before 8.2 +/- 1.3, after 3.0 +/- 1.6) and the dilation group (before 8.3 +/- 1.1, after 2.3 +/- 1.9). There was also a significant decrease of lower esophageal sphincter pressure after treatment in the BTX group and the dilation group. There were no significant differences with regard to overall treatment failure and long-term outcome between patients who had or had not received previous treatment. No major complications were encountered in either group. An actuarial analysis over 48 months comparing patients receiving BTX injection or balloon dilation demonstrated that after 12 months neither therapy was significantly superior. After 24 months a single pneumatic dilation was superior to a single BTX injection, and after 48 months all patients treated by BTX injection had experienced a symptomatic relapse. In contrast, 35 % of all patients treated by dilation and 45 % of patients treated successfully by dilation were still symptom-free in an intention-to-treat analysis after 48 months. When the overall costs of treatment and further treatment after recurrence were compared, dilation and BTX injection showed a similar cost-effectiveness (costs per symptom-free day) after 48 months. BTX injection, which can be performed in an outpatient setting, is as safe and cost-effective as balloon dilation in symptomatic achalasia. Taking into account the lower long-term efficacy of BTX injection therapy, however, it is an alternative only in a minority of older or high-risk patients.
    Endoscopy 01/2002; 33(12):1007-17. · 5.74 Impact Factor
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    ABSTRACT: In the investigation of esophageal transport, the knowledge provided by scintigraphy is mostly based upon the extraction as well as representation of the information obtained. Recently, new tools have been developed for use in computer-based image processing which have made visualization and quantitation of esophageal bolus transport possible through depiction of the 'topography of transit times'. Data extracted from the images obtained in multiple swallowing studies from a single healthy volunteer as well as in patients suffering from gastroesophageal reflux disease (GERD) and from Barrett's esophagus are compressed, filtered and depicted in quantifiable concise plots or multidimensional images. Profile plots demonstrated a considerable increase in local transit times along the esophagus superimposed, however, by a distinctive pattern of local delays. Above the level of the lower esophageal sphincter (LES), the bolus accumulates in a functional ampulla. Subprocesses of bolus transit through the LES, disclosed by spatiotemporal enhancement, allow for the differentiation between mass transit of the bolus and closure of the LES which was considerably retarded in the case of the patient with Barrett's esophagus. The image-processing tools developed for topographic visualization of transit times for esophageal bolus transport have greatly improved the extraction and quantifiable depiction of information obtained by scintigraphy. This can be used for definition of pathognomonic indices.
    Diseases of the Esophagus 02/2000; 13(2):152-60. · 1.64 Impact Factor

Publication Stats

115 Citations
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32.60 Total Impact Points

Institutions

  • 2011
    • HELIOS Klinikum Erfurt
      Erfurt, Thuringia, Germany
  • 2002–2011
    • University of Greifswald
      • • Division of General, Visceral, Thoracic and Vascular Surgery
      • • Department of Surgery
      Greifswald, Mecklenburg-Vorpommern, Germany