Leber, Magen, Darm最新文献

Aneurysms of the hepatic artery are mostly localized extra hepatic (80%). Today atherosclerosis is the most prevalent etiology (32%), followed by trauma (22%) and inflammatory lesions (10%). Rupture or perforation of the aneurysm is the initial clinical manifestation (60-80%), and occurs with nearly equal frequency into the peritoneal cavity and into the hepatobiliary tract. Rupture into bile ducts is often responsible for characteristic findings of upper gastrointestinal bleedings with hematemesis. The case of a 38 year-old man is presented and the clinical manifestation, the diagnostic and therapeutic procedures are demonstrated.

The efficacy of a new combination preparation containing bismuth citrate and amoxicillin in one tablet was compared with the efficacy of bismuth citrate monotherapy in a randomised double-blind study on the eradication of Helicobacter pylori. The study involved 70 H. pylori positive (antrum biopsies showing a positive urease test) patients with non-ulcer dyspepsia and chronic gastritis. The treatment period was 14 days; 35 patients in group 1 received 2 tablets tid containing the bismuth citrate amoxicillin combination (BIAM tablet; 250 mg amoxicillin base and 120 mg bismuth); 35 patients in group 2 were treated with 2 tablets tid containing bismuth citrate (BI tablet; 120 mg bismuth). Total daily dose was therefore 1500 mg amoxicillin + 720 mg bismuth in group 1 patients resp. 720 mg bismuth in group 2 patients. 4 weeks after therapy H. pylori could not be histologically detected in the antrum of 22 patients (63%) in group 1 and 8 patients (24%) in group 2. Thus in group 1 (BIAM) a significantly higher eradication rate (p < 0.001) was shown than in group 2 (BI). Inflammation characterized by the infiltration of polymorphonuclear cells was significantly (p < 0.01) less pronounced in group 1 (BIAM) than in group 2 (BI) 4 weeks after the end of treatment. Gastrointestinal distress was quantified by evaluation of 13 different symptoms using a fourpoints scale at the beginning of the study and after 2 and 6 weeks. The sum of scores decreased by 81% in group 1 (BIAM) and 71% in group 2 (BI) after 6 weeks.

The objectives of medical quality management are optimal diagnosis and patient care. Establishment of quality indicators and respective documentation are prerequisites for quality analysis which is followed by actions to improve quality and renewed evaluation. Internal quality management is increasingly supplemented by external quality management.

Small bowel diverticulosis is in contrast to large intestine diverticulosis an uncommon, acquired entity. In most cases it was found in duodenum and as a Meckel's diverticulum. Jejunal or ileal diverticulosis is a relatively rare disease. Although the majority of the patients do not require surgical treatment because of the absence of clinical signs, in 10% complications may necessitate small bowel resection. The clinical significance, diagnostic evaluation, and treatment of jejunal diverticular disease are reviewed.

146 patients (62 female, 84 male) with chronic hepatitis B were regularly examined in 1 to 2 year intervals with an average follow-up period of 12 years (means). Each time patients were evaluated by physical examination, routine laboratory data, immunological and serological testing, ultrasonography, and laparoscopy and/or percutaneous liver biopsy. No patient of the study underwent immunosuppressive or antiviral treatment at any time. The average time data in years and months are given as the median value (mean). Frequency and date of seroconversion from HBeAg to anti-HBe after the first diagnosis of HBV-infection: in patients with chronic persistent hepatitis (CPH) in 79% of cases after 8 years, in patients with chronic active hepatitis (CAH) in 72% of cases after 7 years, and in patients with liver cirrhosis in 61% of cases after 9 years. The overall seroconversion rate in all patients with chronic hepatitis B amounted to 68% 8.5 years after the first diagnosis of HBV-infection. Clinical and prognostic significance: The seroconversion from HBeAg to anti-HBe mostly led to substantial and sustained biochemical and histologic resolution of liver disease activity. In patients with CPH in 100% of cases after 15 months, in patients with CAH in 87% of cases after 17 months, and in patients with liver cirrhosis in 64% of cases after 2.5 years. 80% of these patients with seroconversion and histologic recovery remained HBV-DNA (PCR)-positive.

We report three cases of mesenteric panniculitis in which the disease took different courses. The first case clinically mimicked an acute diverticulitis and consequently laparotomy was performed. During this operation a large space-occupying tumour was found in the lower abdomen. After resecting this tumour mass of uncertain classification (benign or malignant) a preternatural anus of sigmoid colon was formed. Histological exploration revealed mesenteric panniculitis. Six months later we restored continuity of large bowel by end-to-end anastomosis. No residues of the preexisting panniculitic alterations were seen. The second case concerned a female patient who again complained of discomfort after surgical treatment of colon carcinoma. We measured an elevated erythrocyte sedimentation rate and suspected a relapse of the malignant disease. Notwithstanding radiological and endoscopic diagnostics, the origin and classification of an intra-abdominal tumour could not be determined preoperatively. Laparoscopically we took a biopsy of the local mass, but a definite diagnosis was not found. Postoperatively undulant fever occurred, uninfluenced by cortisone treatment. Finally the patient died because of unstoppable hemorrhage under coagulopathy. Mesenteric panniculitis was identified as causative disease by autopsy.

15 patients with predominantly alcoholtoxic liver cirrhosis (mean age 50 years; 8 men and 7 women) were treated by the technically successful implantation of a transjugular portosystemic stent-shunt (TIPS) within a period of 1 year. The indications for TIPS implantation were the following: gastroesophageal bleedings in 12 cases (10 patients with recurrent variceal bleeding including 2 emergency cases with severe bleeding resistant to conventional therapy and 2 patients with exclusively gastral bleeding due to severe hypertensive gastropathy) and ascites resistant to conventional therapy in 3 cases. Portovenous pressure could be effectively reduced by mean of 37%. Within a mean observation period of 8 months 13 patients including the emergency cases remained without recurrent bleeding. Duplexsonography showed patent stents. 1 patient suffered from an early recurrent bleeding due to occlusion of the stent-shunt. The estimation of liver function according to the Child-Pugh-classification showed only minor changes. Before TIPS 9 patients were in class A, 4 in B, 2 in C; after TIPS 8 patients in A, 5 in B and 2 in C. Ascites resolved completely. Following TIPS all patients appeared to abstain from alcohol. After TIPS 5 from 14 surviving patients (36%) developed clinically manifest encephalopathy within the first 4-8 weeks (2 patients with previous episodes of encephalopathy, 2 other patients after withdrawal of lactulose). By enhanced conservative treatment (lactulose, paromomycine and protein restriction) encephalopathy could be overcome. 8 from 11 surviving patients investigated displayed characteristic MRI changes with an increased signal intensity in the basal ganglia (T1 weighted images). According to our preliminary results TIPS represents a new successful interventional regimen for the treatment of portal hypertension in selected cases.