Leber, Magen, Darm最新文献

For prevention of transfer of infective agents by the contaminated endoscope the importance of thorough mechanical cleaning of the endoscope and adequate disinfection is stressed. Mode of action and side effects of liquid disinfectants as well as resistance of microorganisms (spores and some mycobacteria) to germicidal chemicals are mentioned. The different steps of disinfection procedures and potential causes of failure are discussed. Automatic disinfection systems are required for a higher degree of security of both patient and staff of the endoscopic unit. A regular control of the efficacy of the disinfection process is recommended and models for implementation are discussed. For prevention of occupationally acquired infection general precaution guidelines (use of gloves, prevention of needle-stick injuries) and vaccination programs are stressed.

Infection is one of the hazards of endoscopic procedures. This long known risk has received major concern because of potential HIV infection. In the individual patient, both, patient related factors (such as the compromised host) and procedure related factors (such as tissue damage) determine the risk of infection. The potential for transmission of microorganisms from patient to patient or from the endoscopic equipment to the patient is reviewed. Common sources of infection and relevant microorganisms are listed. For prevention of transfer of infective agents through the contaminated endoscope the importance of thorough mechanical cleaning of the endoscope and adequate disinfection is stressed.

Comparing with malignant lesions or peptic ulcers benign gastric tumors are rare. From 916 patients with gastric diseases, who underwent laparatomy between 1980 and 1993 in the Surgical Department at the University of Cologne, we found only 15 cases (1.6%) of benign gastric tumors. The most common benign tumor of the stomach are leiomyomas followed by adenomas. The majority of benign tumors are asymptomatic. Complaints as hemorrhage or pain are seen of large tumors. Gastroscopy is the most important examination in the diagnosis of benign gastric tumors. Endoscopic polypectomy should be carried out in those lesions still benign. Greater lesions or endoscopically incomplete excised polyps should be treated surgically. Mesenchymal tumors are difficult to estimate in their dignity. The treatment of choice is local surgical extirpation. The postoperative results are excellent.

146 patients (62 female, 84 male) with chronic hepatitis B and 80 patients (34 female, 46 male) with chronic hepatitis C were regularly examined in 1 to 2 year intervals with an average follow-up period of 12 years (mean). 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 are given as the median value (mean). Chronic hepatitis B: Histologic diagnoses and their long-term prognosis: Chronic persistent hepatitis (CPH) on first biopsy: 10% of cases complete recovery after 15 years, 70% progression to chronic active hepatitis (CAH) after 5 years; CAH: 30% advanced remission/complete recovery 8 years after the first diagnosis of CAH, 40% progression to liver cirrhosis after 5 years; liver cirrhosis: 50% advanced remission/recovery 4 years after the first diagnosis of cirrhosis, 5% developed a hepatocellular carcinoma (HCC) 11 years after the first diagnosis of cirrhosis. Natural history: In the 11 years following initial diagnosis of HBV-infection spontaneous recovery was observed in 49% of cases. In 3% of the patients the disease eventually caused death (1 x hemorrhage of oesophageal varices, 3x HCC after 14 to 20 years). Chronic hepatitis C: All patients were anti-HCV- and HCV-RNA-positive.-There was no spontaneous elimination of virus in any patient (maximal follow-up 27 years).(ABSTRACT TRUNCATED AT 250 WORDS)

This is a report on a 67-year-old woman who was admitted to our department with a suspected pseudocyst of the pancreas as diagnosed by ultrasonography performed elsewhere. A percutaneous US study revealed an echo-free space-consuming process measuring 3 cm in diameter and located cranially to the pancreas. On the basis of colour Doppler sonography, a splenic vein aneurysm was diagnosed. An endosonographic examination clearly visualized the aneurysm. Colour Doppler sonographic examination is a valuable diagnostic procedure for the differential diagnosis of "cystic" space-consuming processes in the region of the pancreas.

There is some evidence from anglo-american clinical and experimental studies that gastro-esophageal reflux is more common in patients with laryngitis. Within the framework of an open study, 32 patients with reflux esophagitis and laryngitis were treated with 20 mg omeprazole daily. After 4 weeks at the latest, in all cases inflammation of the esophagus and larynx had healed completely and the patients were without complaints. Suggesting that reflux is the underlying etiology patients with laryngitis seem to benefit from omeprazole.

Vascular malformation and aneurysmal disease of visceral arteries usually exhibit diagnostic problems in upper GI bleeding. In the presented case recurrent massive bleeding caused by an superior mesenteric artery aneurysm was a serious diagnostic and therapeutic challenge. Interventional embolization of the sacciform aneurysm led to a successful treatment and a favourable outcome.