Deutsche Zeitschrift fur Verdauungs- und Stoffwechselkrankheiten最新文献

Biopsies taken from various regions of the duodenal mucosa were investigated with a quantitative histological method with a view to frequency, quantity, and localisation of the duodenitis in clinically proven chronic pancreatitis. The histologic classification of duodenitis was made according to Whitehead et al. Out of 46 patients suffering from a chronic pancreatitis, 19 had a duodenitis grade 1 in the pars superior and pars descendens. A more frequent occurrence of duodenitis with concomitant chronic gastritis or a pathologic condition of the bile duct or a chronic alcohol abuse could not be proved statistically.

In a prospective study 187 patients with diffuse fatty infiltration of the liver, estimated by ultrasound tomography, were investigated. In any case the history as well as the results of clinical investigation and the lab findings were known to the observer. Liver blind punctions were performed after a short time, on an average of 11 days. In 91.4% the sonographic diagnosis "fatty infiltration of the liver" could be confirmed by histological findings, while in the other cases the diagnosis was incorrect or incomplete respectively. Following sonographic criterions any results were graduated into three groups and compared with the percentage of fat infiltrated liver cells found by histological investigation. There was a high accuracy in patient with fatty liver: 90.9% could be established by ultrasound tomography. Only in those cases, in which the sonographic diagnosis "fatty infiltration" is not confirmed by case history, clinical and lab findings, the liver biopsy is to be performed.

The transepithelial potential difference of the gastrointestinal mucosa as a diagnostic parameter obtains increasing importance in clinical medicine. Therefore it is necessary to consider methodical aspects of the tPD-measurement under in-vivo conditions. The current paper presents methodical considerations for instance electrode arrangement, positions, composition of the electrolyte electrodes, diffusion potentials, rate of perfusion and unstirred water layer and their influence on the tPD-measurement.

The pathogenesis of the hepatic encephalopathy (HE) in spite of substantial progresses in this field still rests unclear. Actually four main hypotheses of the pathogenesis are discussed: the ammonia-hypothesis, the synergism-hypothesis, the hypothesis of the false neurotransmitters and that one of the changes of the normal neurotransmitters and their receptors. A connecting function seems to come up to ammonia. --Reduction of oral protein intake, selection of certain proteins, oral administration of nonabsorbable antibiotics and enemas should be used in order to prevent the intestinal absorption of toxic metabolic products. The parenteral nutrition has the therapy of HE substantially improved. Primarily, the patients receive special amino acid mixtures with a high content of branched chain amino acids and a low content of aromatic acids. The exchange of carbohydrate to some extent through fat improves the parenteral nutrition regime for these patients. The different liver support systems have failed to improve the prognosis of fulminant hepatic failure.

Clinical manifest hypothyreosis leads to changes of plasma lipoproteins, which are characterized by elevated LDL levels, an increase of the relation LDL cholesterol/HDL cholesterol, an elevation of the quotient cholesterol/triglycerides within the VLDL and an increase of the relation HDL2/HDL3. Both these changes and the diminished activities of post-heparin lipase of hepatic and extrahepatic origin are reversible after substitution therapy. On the contrary, patients with hyperthyreosis M. Basedow show low lipoprotein levels, high activities of post-heparin lipase and an elevation of the relation of the apolipoproteins apo C II/apo C III within the VLDL fraction.

This study presents clinical, endoscopical and histological primary findings of solitary ulcer of the rectum obtained in 24 patients. Solitary ulcer of the rectum is preferably a disease of young women. The main symptom is recurrent rectal bleeding. Endoscopically in 50% of all cases mucosal ulcerations can be observed. The other cases are non-ulcerous lesions with uncharacteristic endoscopical findings. The majority of the lesions are within 6-8 cm of the anal margin. In 44% of the patients there are findings, which are suspicious of preexisting rectal prolapse. The histological main criterion is a fibromuscular hyperplasia of the lamina propria. Full agreement of endoscopical and histological diagnosis at primary examination could be obtained in only 17% of the cases.

110 patients with benign gastric ulcer and concomitant joint diseases (rheumatoid arthritis, osteoarthrosis) were treated in a comparative short-term clinical trial to assess the relative efficacy of calcitonin (daily 100 MRC of salmon calcitonin intramuscularly), cimetidine (daily 1000 mg orally) and colloidal bismuth subcitrate (De-Nol-four times a day in doses of 5 ml diluted with 15 ml of water). Groups of patients were comparable according to age, sex, duration of ulcer disease, smoking habits, gastric acid secretion and mean ulcer size. The ulcer healing was controlled endoscopically after 2 and 4 weeks of the treatment. There was no significant difference in the ulcer healing rate between three groups neither after 2 weeks (calcitonin-36.7% of healed ulcers, cimetidine-37.5% and De-Nol-35.0% nor after 4 weeks respectively (76.7%, 72.5% and 77.5%). In the calcitonin group a gradual joint pain relief was observed in 84% of patients who complained arthralgia. The moderate side effects (headache, nausea, flush) were observed only in the patients treated with calcitonin (8 subjects). We suggest that calcitonin may be considered as a valid anti-ulcer drug in the peptic ulcer patients with concomitant rheumatological diseases especially with osteoporosis.

Case report about a carcinoma of the appendix, recognized by obduction of an 58-years old man. Discussion of rarity, difficult clinical diagnostic, histological classification, metastasis and problems of differential diagnosis and therapy.

Benign tumors of the gallbladder are rare. Under them often is found the adenomyoma. About 13 of such cases is reported. They are not true neoplasias and will be called as tumorlike lesions. Clinical and aetiological problems are discussed.

pH was measured continuously in the lower duodenum before and 90 min after a standard meal in 15 controls and 13 patient with severe pancreatic insufficiency (PI); gastric acid secretion was unimpaired in all of them. 7 out of the 13 pat. with PI received additionally 30 ml of an A-Mg-silicate preparation (MegalacR) 45 min after the meal. Mean pH dropped after the meal from 6.9 to 6.2 in the controls and from 7.1 to 4.9 in the pat. with PI. The overall time of pH-values below 5 amounted to 0.5% of the measuring period in the controls, in PI-pat. to 35%. In pat. with PI there were additionally pH-values below 4 during 11% of the postcibal period. Antacid administration increased duodenal pH significantly but only over 15 min; this transient effect had, however, no significant influence on the overall time of the pH-values below 5 and 4. Al-Mg-silicate has obviously no relevant effect on the postcibal duodenal pH in pat. with PI and can therefore not be regarded as a means to prevent inactivation of pancreatic enzymes in the duodenum.