Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten最新文献

An analysis of 70 case records from the literature of patients with familial polyposis or Gardner syndrome and adenomas or carcinomas of the small bowel demonstrated that there is no difference between the neoplasms of the small bowel in familial polyposis or in Gardner syndrome. Between the adenomas and the carcinomas of the small bowel it was possible to show, that there exists a similar close relation as in the large intestine. In some carcinomas of the small bowel rests of adenomas can be observed. The peak incidence of small bowel adenomas is more than a decade earlier than that of carcinomas. The distribution of adenomas in the small bowel is quite similar to that of carcinomas. Therefore it can be supposed, that the significance of familial polyposis coli and Gardner syndrome for the importance of an adenoma-carcinoma-sequence in the large bowel is also existing in the small bowel.

Dependent on the profession, medical personal is at different risk of hepatitis B infection. 505 staff members of 48 Berlin dental clinics were investigated for hepatitis B virus markers and demonstrated a significantly lower prevalence of HBsAg and its antibody than other hospital personal: anti-HBs positivity (EIA) was found in only 5.5 per cent of them (dental technicians: 1.6%, dental assistants: 3.8%, dentists: 8.0%). We conclude that in the GDR dental staff is not at higher risk of hepatitis B infection than other non-risk medical personal. Legal aspects of insurance and measures for hygienic prevention in dental practice are discussed.

It is reported on results of a double blind study of colchicine therapy in fibrotic liver diseases over a period of three years. The study includes 74 probands; 37 of them had been treated after randomization for five days a week with 4 X 0,25 mg/d colchicine, 37 with placebo. 53 probands attained the 12th month of treatment, 43 of them 24th, 24 probands were in the study for 36 months. 3 diagnoses groups had been formed with regard to the histological grades of fibrosis: chronic hepatitis (without structural transformation); structural liver transformation/moderate liver cirrhosis; severe liver cirrhosis. In 38 cases the disease was caused by alcohol. 45 data had been studied (clinical results, paraclinical data concerning hepatological diagnostic and connective tissue metabolism and morphologic data). The biometric evaluation was carried out with the stage variant analysis by Friedman. Rebiopsies have been carried out in 40 probands after 1 year, in 4 probands after 2 years. 4 data (Serumalbumine, Gamma-GT, ALAT, KP) showed significant changes in the colchicine-group as well as in the placebo-group. In both therapy groups the morphologic supervisions of the fibrosis grades (rebiopsies) showed improvements, no changes, and deterioration about in the same frequency. In this study there was no effectiveness of colchicine on the course of fibrotic liver diseases to be stated. Concerning the contradictions in the recent literature and probable the insufficient colchicine dose, the authors recommend further studies on colchicine therapy in liver diseases with incipient i.e. reversible fibrosis.

A procedure to collect pure pancreatic juice endoscopically is described which allows an instant estimation of the protein content of the secretion by measuring its absorption at 280 nm. By this the kinetics of protein secretion can already be read from a curve during the collecting procedure, thus avoiding a multitude of small fractions otherwise necessary. Timing and size of the samples are adjusted individually according to the course of protein secretion and not to a rigid regimen. The method described is especially apt to investigations of pancreatic proteins and substances the secretion of which parallels that of protein; e. g. trypsinogen, calcium and zinc, however not sodium and potassium.

Unlabelled: Up to the middle of 1985 a survey of endoscopic papillotomy (EPT) had been carried out in the GDR resulting in 3124 patients from 8 centers.

Indications: choledocholithiasis 90.6% (13.1% with a T-drain, 16.2% with a gallbladder in situ); papillary stenosis 4.4%; tumors of the papilla 2.2%; other indications 2.2%. The common bile duct got free of stones in 89.3% of 2210 documented cases after successful EPT. In comparison to former results in 1982, 1983 and 1984 (cumulated data) the technical success rate of EPT rose slightly, but steadily to 95.3%, and the complication rate fell to 5.8%. Bleeding was the most common complication followed by cholangitis, pancreatitis, basket impaction and perforation. 30 patients (0.96%) died due to complications, 14 with pancreatitis, 7 cholangitis, 7 bleeding, 2 perforation.

A transcatheter embolisation was carried out for treatment of a patient suffering from hepatic metastases of a malignant carcinoid tumour. Recurrent and very severe carcinoid symptoms could be observed; a bronchial carcinoid supposingly the primary tumour without characteristic symptoms was removed six years before. The carcinoid symptoms became resistant to pharmacological agents and finally ended in life-threatening clinical complications. The transcatheter hepatic artery embolisation was successfully performed and repeated three months later. After embolisation relief of carcinoid symptom and a significant decrease in 5-hydroxyindole acetic acid (5-HIAA) urinary excretion lasting for eight months could be observed. There were no serious complications with adequate pharmacological cover, however, a transient fever, leucocytosis, abdominal pain and an increase in serum transaminase activities occurred after the procedure. The transcatheter hepatic artery embolisation should be a method of choice for treatment of patients with carcinoid metastases producing severe carcinoid symptoms resistant to pharmacological agents.

In a case of Whipple's disease with electron microscopic demonstration of rod-shaped bacteria we could isolate Propionibacterium acnes (former name: Corynebacterium anaerobium), Actinomyces, and Lactobacillus from duodenal biopsies by the aid of modern anaerobic culture technique. Simultaneously we found a dysbiosis (increase of anaerobic coca and anaerobes) in du odenal juice. After antibiotic treatment Propionibacterium and Lactobacillus disappeared and an other type of dysbiosis (appearance of Bacteroides) was to be seen. In discussion is a change of immunologic state and following disturbed regulation of microbial colonization in the small bowel of patients with Whipple's disease.

The first appearance of sulpharyridine in plasma was investigated in nine healthy informed male volunteers. In a three way crossover design 6 g salazopyrin alone, together with metoclopramide (0.3 mg/kg i.m.) or atropine (0.01 mg/kg i.m.) were given. Sulphapyridine appears in the blood at the (means +/- S means) 6.2 h +/- 0.8 h (range: 3-11 h) in controls. Together with metoclopramide the first appearance is 3.6 h +/- 0.7 h (range: 2-8 h) and together with atropine these values are 8.1 +/- 0.8 h (range: 6-12 h). The differences are significant with p less than 0.05. The results show the pharmacological modification of motility in the gastrointestinal tract and in consequence the usefulness of salazopyridine to determine the transit time.

Reactions of cell-mediated immunity are investigated in 32 healthy controls and 134 patients with chronic liver diseases (E-rosette-forming cells, lymphocyte transformation test, leucocyte migration inhibition test using the T-cell-mitogens Phytohaemagglutinin and Concanavalin A). The number of E-rosette-forming cells is significantly decreased in chronic active hepatitis, alcoholic hepatitis and cirrhosis. The 3H-thymidine uptake in the lymphocyte transformation test by use of PHA and Con A is markedly reduced especially in active and progressed liver diseases. PHA caused a significant higher inhibition of leucocyte migration in patients with alcoholic hepatitis and cirrhosis than in healthy controls. A dependency between the results of the two tests is not detectable (Chi 2-test). We found in individual cases of groups with liver diseases serum inhibition factors by MIT, but not correlations with other immunological or clinical-chemical parameters. The pathogenetical value of the used methods in cases with chronic liver diseases is questionable.

From 1970 to 1983 1,000 successful peroral intestinal biopsies were carried out at the children's Hospital of the Medical Academy Dresden. No complications such as perforation or bleeding appeared. Peroral intestinal biopsy has a preeminent importance in the diagnostic of coeliac disease. Certain paraclinical parameters in children with coeliac disease were correlated with bioptically recordable small intestinal mucosa changes; from which following results and conclusions can be drawn: Neither reticulin nor gluten antibodies can be recommended as screening parameters for the peroral intestinal biopsy. The determination of reticulin antibodies is better suited for diet checking because of its greater specificity . During the acute phase of coeliac disease 50 per cent of the cases are to be expected to have decreased serum zinc levels. A short-term zinc substitution is to be recommended. An increased number of pathological EEG's can be found in children with coeliac disease; particularly after a longterm gluten-containing diet. Therefore gluten-provocation to diagnose a coeliac disease should be performed after the 6th year of life, this is after completion of the cerebral cell differentiation.