[Acute segmental hemorrhagic antibiotic-associated colitis]. / Akute segmentale hämorrhagische antibiotikaassoziierte Kolitis.

Three cases of acute segmental hemorrhagic antibiotic-associated colitis are described occurring in three male adults between 30 and 33 years of age after treatment with oral ampicillin or amoxicillin because of upper respiratory tract infection, tonsillitis, or HLO eradication therapy, respectively. All presented with cramping abdominal pain and bloody diarrhoea of acute onset, however, microbial analysis of fecal samples was negative. Endoscopy showed right-sided segmental hemorrhagic colitis. Histopathological examination demonstrated edema, patchy superficial hemorrhage and a scattered predominantly mononuclear infiltrate of the lamina propria. The surface epithelium was partly desquamated and displayed foci of grouped intraepithelial red blood cells. All patients spontaneously recovered after discontinuation of antimicrobial therapy. The value and limitations of diagnostic features are discussed with respect of the literature.

Cure with omeprazole plus amoxicillin versus long-term ranitidine therapy in Helicobacter pylori-associated peptic ulcer bleeding.

BACKGROUND: Long-term prophylaxis with ranitidine reduces the risk of recurrent bleeding in patients with a history of bleeding peptic ulcers. To date, no randomized study has been performed to compare cure of Helicobacter pylori infection versus H2 blocker prophylaxis in patients with bleeding peptic ulcer. METHODS: In a prospective randomized study, 95 consecutive patients with H. pylori-associated peptic ulcer bleeding were randomized to either ranitidine prophylaxis (150 mg at night) for 2 years or to H. pylori-eradication with omeprazole 60 mg twice daily plus amoxicillin 750 mg three times daily for 10 days. RESULTS: (Intention-to-treat analysis). Forty-eight patients were enrolled in the ranitidine group; 47 in the omeprazole-plus-amoxicillin group. Mean follow-up was 576 days (77 to 730). Ulcer recurrence rate was 31.3% in the ranitidine group (group 1) versus 6.37% in the eradication group (group 2; p = 0.0018). More patients had recurrent bleeding in group 1 (8.3%) than in group 2 (4.2%) but we were not able to show a statistically significant difference with respect to recurrent bleeding between groups (p = 0.29). Definite cure of H. pylori infection was achieved in 89.3%. CONCLUSIONS: Cure of H. pylori infection reduces recurrence of peptic ulcer and therefore rebleeding more effectively than does long-term maintenance therapy with an H2 blocker.

Management of esophageal perforations after therapeutic upper gastrointestinal endoscopy.

BACKGROUND: Esophageal perforation is one of the most dreaded complications in therapeutic gastrointestinal endoscopy. We assessed the frequency of esophageal perforation after endoscopic procedures in a highly specialized endoscopy unit and compared clinical outcomes in patients undergoing either surgical or conservative management. METHODS: From January 1985 to June 1996, 1011 instrumental endoscopic procedures (dilatation and bougienage) were performed in our department. The computerized complication database was searched to identify all patients with esophageal perforation during this same period, and their records were reviewed. RESULTS: Seventeen esophageal perforations (1.7%) occurred in the course of 1011 procedures. Four perforations resulted from balloon dilatation, and 13 were secondary to bougienage. Six patients were managed surgically (35%), all of them recovering uneventfully. Eleven patients were managed conservatively, mainly because they were unfit for surgery. Survival rate in this group was 82%; only two patients died, both of whom had underlying malignant disease. CONCLUSIONS: The current concept in management of esophageal perforations comprises surgical as well as medical treatment. In well-selected cases, non-operative treatment can be considered with favorable results.

[Endoscopic fibrin gluing of a pancreatic duct fistula following acute pancreatitis]. / Endoskopische Fibrinverklebung einer Pankreasgangfistel nach akuter Pankreatitis.

HISTORY AND CLINICAL FINDINGS: A 45-year-old patient was admitted because of frequent attacks of upper abdominal pain after food intake. The pain episodes had started shortly after a bout of acute pancreatitis. Physical examination was unremarkable except for mild pain on palpation of the left lower abdomen. INVESTIGATIONS: Amylase and gamma-glutamyl transaminase activities as well as inflammatory parameters were slightly raised. Ultrasonography was suggestive of a circumscribed area of necrosis in the tail of the pancreas, a finding confirmed on endoscopic retrograde injection of contrast medium, which passed into the necrotic cavity via a fistula. TREATMENT AND COURSE: The fistula failed to close during 12 days of conservative treatment (total parenteral nutrition; 2 g ceftizoxim twice daily; 1 ampoule somatostatin daily). In three sittings during 6 days, 1-2 ml fibrin glue injections were made by endoscopy retrogradely into the fistular passage resulting in its complete occlusion without any further complications. CONCLUSION: A previously treatment-resistant pancreatic fistula can be successfully occluded by injection of fibrin glue by retrograde endoscopy, obviating surgical intervention with subsequent reduction in glandular capacity.

[The feasibility of ultrasonography for the evaluation of stomach motility disorders]. / Möglichkeiten der Sonographie bei der Beurteilung von Magenmotilitätsstörungen.

The value of measuring gastric emptying time by ultrasonography in disorders of gastric motility was first assessed in a control group (26 men, 24 women; mean age 51 [23-83] years. Some were healthy volunteers, others were patients without any gastrointestinal disease, the results serving to standardize the method (planimetry of the antrum; 300 ml water as test substance). The mean gastric emptying time (GET) was 24.9 +/- 4.7 min. After this the method was applied in 48 patients (29 men, 19 women; mean age 57.5 [15-90] years) with diabetes type I (n = 14) or II (n = 34) and 59 patients (18 men and 41 women; mean age 54.8 [26-74] years) with functional dyspepsia. GET was 35.9 +/- 12.7 in the diabetics, significantly longer than normal (P < 0.0001). 24 diabetics (50%) had a prolonged GET (> or = 40 min) independent of type, duration and treatment of the diabetes, but more common if the blood sugar level was poorly controlled and there was late diabetic neuropathy. GET was also significantly prolonged in patients with functional dyspepsia (31.4 +/- 9.7 min; P < 0.055). There was a positive correlation with the clinical dismobility type of the dyspepsia. It is concluded from the findings that ultrasonographic measurement of GET successfully identifies noninvasively abnormal gastric motility in different types of disease.

[Effect of the geometry of atherosclerotic carotid artery lesions on their angiography image--an arteriography study]. / Einfluss der Geometrie atherosklerotischer Karotisläsionen auf deren angiographische Darstellbarkeit--Eine arteriographische Studie.

Atherosclerotic lesions of the carotid arteries are frequently located eccentrically and are of asymmetric configuration. For their angiographic detection at least two orthogonal views are mandatory. The carotid bifurcations, the proximal internal carotid artery and the carotid siphon can be visualised free from vessel overlap only via often mandatory lateral views that must be obtained by selective arteriography (IA DSA). Smaller lesions and ulcerations of the carotid bifurcation area may be misinterpreted with nonselective IA DSA and IV DSA because of their geometry.

[Distribution pattern of atheromatous lesions of the carotid circulation--significance for the angiographic strategy of cerebrovascular insufficiency]. / Verteilungsmuster atheromatöser Läsionen der Karotisstrombahn--Bedeutung für die angiographische Strategie bei der zerebrovaskulären Insuffizienz.

Atherosclerosis of the cervico-cerebral arteries is a generalized disease which frequently involves the whole carotid system. The bifurcations (48.7%), the proximal 2 cms. of the internal carotid arteries (61.6%) and the carotid siphons (60.3%) are most frequently affected. Angiography may demonstrate ulcerated lesions in up to 25% of cases. "Tandem stenoses" in both the extracranial segments of the carotid arteries (4.6%) and isolated hemodynamically significant stenoses in the carotid siphons (.7%) are uncommon. Nevertheless their presence may play an essential role in therapeutical decision making. Because of the multiplicity of lesions, the claim for preoperative selective arteriography is justified. IA DSA may replace film angiography, if image quality and medical information are identical. IV DSA and Doppler-procedures as a rule cannot replace selective arteriography in preoperative work-up.