Leber, Magen, Darm最新文献

Between November 1985 and January 1994 a total of 239 patients were operated for replacement of the esophagus and primary reconstruction. Of these 3 had benign disease and 236 had malignancy. Continuity of the alimentary tract was restored in 202 cases by stomach transposition, in 16 cases by colon interposition and in 21 cases by free jejunal autograft. Complication rate of surgical resection was 36.8%, lethality 5.1%. Lethality of coloninterposition was as low as for gastric transposition (6.3 vs 5.5%). None of the patients with free jejunal autograft died during hospital course (p < 0.001). Survival rates by life-table analysis for the whole group were 65%, 42%, 36%, 32%, and 22% after 1, 2, 3, 4 and 5 years, respectively. The malignant tumors consists of 111 esophageal carcinomas, 104 carcinomas of the esophagogastric junction and 21 carcinomas of the hypopharynx. 15.1% of the tumors were staged I, 42.7% II, 35.7% III and 6.5% IV. The collectives for esophageal carcinoma and cardia carcinoma were equal for age, sex, and distribution of tumor stages. The survival rates for both groups were similar. Differences occurred in a three times higher rate for concomittant hiatal hernia and history of reflux esophagitis in the cardia carcinoma group.

Normally colonic diverticulitis presents itself clinically with symptoms. In our presentation pyogenic liver abscess was the primary finding of a concealed perforation of sigma colon diverticulitis. Investigations, diagnostic procedures and therapy are presented.

Surgery for chronic pancreatitis is criticized as being too risky to treat an allegedly self-limiting disease. Therefore, analysis of treatment results after surgery is necessary. Relevant parameters are--besides late surgical complications--pain, exocrine and endocrine insufficiency, weight loss, regular medications, general fitness and ability to work, all of which have to be accounted for pre and postoperatively. All parameters were integrated into an outcome score. 64 patients were studied 3.5 years (median) after different surgical procedures for proven chronic pancreatitis. Efficient pain control was achieved with every procedure. Resection caused more often functional deficiencies. However, these patients felt generally fitter after surgery and more often worked full-time. The outcome score demonstrated different results for the various procedures. Especially the risk-benefit ratio of cystoenterostomies can probably be improved by percutaneous drainage techniques.

The case of a 78 years old patient with impressive flush symptoms is reported. 5-Hydroxyindoleacetic acid and serotonin were elevated. The responsible pathomorphological structure is a 8 x 4.5 x 6 cm ileocaecal neoplasm. Pre-, intra- and postoperatively liver metastases could not be detected during a 18 month period. After surgery of the carcinoid flush disappeared, so that the tumour seize resulting in enormous secretion of metabolites with endocrine activity should be claimed responsible for causing this symptom.

Due to the complexity of interacting organ systems, in vivo the interpretation of results obtained from whole-animal experiments of acute pancreatitis remains difficult. To enlighten cause-and-effect-relationships, functional isolated parts of the pancreas are applied increasingly in research into the pathogenesis of the disease, therefore. By means of a collagenase digestion technique, intact acinar cells from normal as well as from pretreated rat pancreas could reproducibly be obtained in high yield. Animals were pretreated in situ by induction of either mesenteric ischemia/reperfusion, juice edema, or acute pancreatitis (AP). Pancreatic acinar cells isolated from these pretreated rats consumed oxygen at comparable rates under resting conditions throughout all experimental groups. A reduced stress capacity of cell respiration as well as a preterm decline in short-term culture was observed in the cells of the AP group, however. These results demonstrate that the induction of AP has found its reflection within the acinar cells themselves. Interestingly, these effects were not clouded by the isolation procedure. The manner of in-situ pretreatment of the respective animal proved to be decisive for later viability of isolated acinar cells in short-term culture. Uncoupling of oxidative phosphorylation by 2,4-dinitrophenol (DNP) lead to an accelerated decline of the acinar cells in all groups. The intactness of cellular energy metabolism seems to play a crucial role in maintaining cellular integrity, therefore. In additional experiments in vitro, the intracellularly mediated cell damage by DNP was compared with one induced from the extracellular environment of isolated cells by antibodies directed against cell surface antigens plus complement.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined therapy with the proton pump inhibitor omeprazole and amoxicillin has become an important alternative in the treatment of ulcer disease associated with Helicobacter pylori infection. Due to the high efficacy in eradicating H.pylori, missing resistance of H.pylori against amoxicillin and high tolerability and digestibility this regimen may be recommended for widespread routine use. In a randomized, double-blind multicenter trial an H.pylori eradication rate of over 90% has been achieved for the first time by dual therapy using a daily omeprazole dose of 120 mg (3x40 mg) in combination with 3 x 750 mg amoxicillin for 14 days, which is comparable with classical triple therapy containing bismuth and two antibiotics. On the basis of an "intention-to-treat-analysis" dual therapy of omeprazole 3x40 mg + 3x750 mg amoxicillin is considered at present to be the most effective regimen for the treatment of H.pylori-associated diseases.

Cholangiocarcinoma affects both sexes equally, is more prevalent in individuals age 50 to 70. Associations with many other diseases are known, in particular with primary sclerosing cholangitis, ulcerative colitis and parasitic infestation (Clonorchis sinensis, Opisthorchis viverrini). About 95% are histopathologically classified as adenocarcinoma. The localisation of the tumor determines clinical course and prognosis. If the tumor is located above the hepatic duct bifurcation, only one side of the biliary tree may be obstructed, resulting in atrophy of the corresponding liver lobe, without clinical manifestation of jaundice. Obstructive jaundice is the characteristic symptom of hilar tumor localisation. Laboratory examinations show hyperbilirubinemia and liver enzymes indicating cholestatis are elevated. Pathological levels of the tumor markers carcinoembryonic antigen (CEA) and CA 19-9 are frequently found. Ultrasonography in combination with endoscopic retrograde or percutaneous transhepatic cholangiography and cytological examination of aspirates are of main diagnostic importance. Treatment consists of curative resection or palliative decompression to relieve jaundice, the latter can be performed using endoscopic implantable self-expanding metal stents. Cytotoxic chemotherapy or liver transplantation show no satisfactory results. The prognosis is mainly poor, only few patients survive more than 6 months after diagnosis.