Summary. Seventeen patientswith pancreatic pseudocysts were treated by endoscopic drainage. In nine cases we performed endoscopic retrograde pancreatic drainage (ERPD) by inserting 7-Fr pigtail catheters via the papilla into the cyst or into the main pancreatic duct. In two cases transduodenal cystotomy (ECD) and in eight cases transgastral cystotomy (ECG) are performed by using coagulator and papillotome. In five cases of ECG an endoprosthesis was inserted into the cyst. In two cases combination therapy of ERPD and ECG was performed. All patients reported reduction of continuous pain and postprandial epigastralgia after placement of endoprosthesis. After disappearance of symptoms and abnormal endoscopic findings within a period of 2-12 months the drainage tubes were removed. In one case postoperative dislocation of the prosthesis was observed; no serious complication was not encountered. The period of observation varied from 5 to 40 months. Two patients are presently under treatment with endoprostheses. Endoscopic drainage yielded good results in the treatment of pancreatic pseudocysts. Key words: Pancreatic pseudocyst-Endoscopic drainage -Transduodenal cystotomyPancreatic pseudocysts require drainage if they cause symptoms such as pain or loss of appetite or complications like bleeding, infection, or jaundice due to compression of the common bile duct. Asymptomatic but large cysts with a high risk of developing complications should also be treated by drainage. Many therapeutic procedures such as external drainage with nasocystic tubes or CT and sonographically guided percutaneous drainages exist.The rates of recurrence, however, amount to 20-25%, and there are many cases of persistent pancreatiOffprint requests to: M. Dohmoto cocutaneous fistula. The conventional surgical treatment by construction of an internal connection between the cyst and the gastrointestinal tract has a high rate of complication and mortality. So endoscopic procedures with the advantage of less complications and less discomfort for the patient have been developed recently.
Recently, endoscopic interventional procedures were introduced for nonsurgical therapy of symptomatic pancreas pseudocysts. We reported 25 patients treated by endoscopic retrograde pancreas drainage (ERPD), endoscopic cystogastrostomy (ECG), or endosopic cystoduodenostomy (ECD). ERPD was performed in 9 patients by placement of a 5 Fr. or 7 Fr. endoprosthesis transpapillary into the cyst or the main pancreatic duct. ECG was carried out in 10 cases, in 7 of these, a double pigtail catheter was additionally inserted. Three patients suffering from pseudocysts of the pancreas head were treated by ECD. In a further 3 cases, ERPD and ECG were combined. All patients reported a dramatic reduction of pain with a simultaneous increase of appetite and body weight. The drainage tubes were removed after disappearance of symptoms, and abnormal clinical and endoscopic findings within 2 to 12 months. In 4 cases, a recurrence of the cyst was found 10 and 22 months later, in 3 cases the endoprostheses had to be renewed because of catheter occlusion or dislocation. 2 patient underwent surgical treatment after insufficient endoscopic drainage due to haemorrhage or recurrence. Endoscopic treatment of pancreatic pseudocysts yielded good results with low rates of recurrence and complications. According to our experiences we think endoscopic interventional techniques will oust surgery from its present dominant position in the next years.
Zusammenfassung Hintergrund Stürze und sturzbedingte Verletzungen gehören zu den großen Herausforderungen heutiger industrieller Gesellschaften. Die bekanntermaßen effektiven gruppenbasierten Trainingsprogramme sind jedoch gerade in ländlichen Gebieten unzureichend verfügbar. Ziel Nach erfolgreicher Implementation der Trittsicher-Bewegungskurse in ausgewählten ländlichen Regionen Deutschlands war das Ziel der Analyse, die Gründe der Teilnahme und Adhärenz durch 6 Fokusgruppeninterviews zu identifizieren. Methode Die Daten wurden mittels inhaltlich-strukturierender Analyse nach Mayring 1 analysiert und einem deduktiv gebildeten Kategoriensystem zugeordnet. Zusätzlich wurden quantitative Daten deskriptiv analysiert. Ergebnisse In den Kategorien erwarteter und wahrgenommener Nutzen, Merkmale der Kursleitung, sozialer Zusammenhang, Empowerment sowie Motivation und Design des Programms fanden sich Kriterien, die eine Teilnahmewahrscheinlichkeit und Adhärenz erhöhten. Schlussfolgerung Die hier analysierten Kriterien sollten bereits bei der Planung von neuen Bewegungsprogrammen mit den Erwartungen der Zielgruppe abgeglichen werden.
"Trittsicher" mobility courses are a new specific offer to improve mobility and reduce the risk of falling. They contribute to a better care of older people in rural areas.
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