Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis最新文献

Diagnosis of endocrine pancreatic tumor syndromes is based on the characteristic spectrum of symptoms and the demonstration of inappropriately high serum levels of the tumor's secretory products. Available imaging methods cannot visualize pancreatic tumors with a diameter of less than 1 cm and are diagnostic in 50 to 60% only. With the introduction of endoscopic sonography and somatostatin receptor scintigraphy, detection of tumors has been improved. Therapeutic principles include surgical extirpation, primarily in the absence of metastases, and medical control of symptoms. In the case of metastatic disease, tumor growth and symptoms can be controlled by a variety of procedures including somatostatin analogs with and without additional alpha-interferon, polychemotherapy, embolization, surgical tumor debulking and liver transplantation.

Transthoracic and transmediastinal resection without thoracotomy are the two possible surgical procedures for treatment of esophageal carcinoma. The transmediastinal procedure lends itself particularly for carcinomas in the distal part of the esophagus. The indication for operation is based on an exact preoperative tumor-staging. Primary surgery is only indicated, when R0-resection seems possible. Otherwise multimodal therapeutic concepts and palliating treatment should be preferred. The extent of lymphadenectomy, standard-lymphadenectomy, two-field- or three-field-lymphadenectomy are currently disputed. Extensive lymphadenectomy seems to yield significantly better prognosis in early esophageal carcinoma. The importance of multimodal therapeutic concepts is not yet sufficiently defined. Further studies are needed.

The management of acute pancreatitis (AP) is symptomatic and is adjusted to the clinical course of the disease, which is assessed by different clinical variables, laboratory findings as well as by contrast-medium-enhanced computed tomography. The therapy of AP consists of a general basic treatment (fluid substitution, antibiotics, etc.) and additional measures according to intensive-care principles. Antisecretory substances such as glucagon, calcitonin and somatostatin are ineffective; the value of peritoneal lavage and early ERCP with EPT as standard treatment is still under debate. Surgical treatment is only indicated if the clinical course worsens various of the supportive measures.

In this study the most important Swiss studies on the incidence of overweight and obesity are summarized and compared to the corresponding prevalence rates from the Heureka study. Interestingly, data on body weight indexes (mostly mass indexes) and the various prevalence rates showed good accordance for younger age groups. In the upper age classes however, phenotypic differences concerning determinants and risk factors for overweight became obvious in the different Swiss populations (i.e. from geographically different regions of Switzerland). Nevertheless, regional risk factors could not been detected because specific data were lacking. The importance of uniform weight definitions for studies as well as for daily practise is stressed.

Leprosy had a great impact on everyday life during the Middle Ages, which is reflected in many works of art and also in some preserved buildings. Worldwide, leprosy is still an unsolved problem; this fact has led the World Health Organization to develop a specific strategy to fight the disease. For physicians in Europe, leprosy has lost its significance. In the archives of the Swiss Canton of Valais leprosy in the 20th century is documented by photographs and written records. It is deplorable to see how a young woman can become crippled, lose her eyesight and die within a couple of years. Probably a pocket of leprosy persisted since the Middle Ages in this remote mountain area. The limited contagiousness of the disease is astonishing, since only a few of the closest family members and inhabitants of the some house were infected, while others remained healthy. The social situation of these patients at the beginning of this century was pitiable. The federal laws on epidemics of 1886 did not mention leprosy, as no one seemed to believe in its existence in Switzerland. Even after the cases of leprosy in the Canton of Valais were revealed, the reaction of the political authorities was reserved. An engaged effort by the involved physicians was necessary to establish the appropriate hygienic measures. In the literature of the time there were regular reports of cases in people who emigrated from the endemic areas. Today, in Switzerland one case of leprosy is discovered per year; thus, leprosy is still a disease which physicians must cope with.

A 28-year-old turkish patient was admitted to hospital several times within the last years because of acute abdominal and thoracic pain. On each admission laboratory parameters indicative of an acute inflammatory process were initially found to be slightly increased; however, the cause for the complaints remained undetected. During a recent episode of acute abdominal pain a short increase of these laboratory parameters (particularly of CRP) could be documented, and since no other diagnostic sign indicative of an other disease was found, familial mediterranean fever was diagnosed. A basic therapy with colchicine was initiated, and since five months the patient remained mostly free of symptoms.