[Endoscopic removal of an intraluminal duodenal diverticulum in an adult with upper abdominal pain]. / Endoskopische Spaltung eines intraluminalen Duodenaldivertikels beim Erwachsenen wegen Oberbauchbeschwerden.

We report here on a 44-year-old previously healthy patient with a two-year history of intermittent upper abdominal pain. In the outpatient gastroduodenoscopy and X- ray examinations of the small intestine an intraluminal duodenal diverticulum was suspected. Clinical examination and laboratory tests did not show any abnormal findings. In order to exclude other causes for the patient's complaints coloscopy, ERP and MRCP were performed. The latter was done because the bile duct could not be intubated in the ERCP due to the altered anatomy. By use of endoscopic ultrasound a mucosal duplication was demonstrated and thus the diagnosis confirmed. Subsequently, the diverticulum sac was sliced by argon plasma coagulation. The postinterventional course was without complications and the patient was without symptoms afterwards. The intraluminal duodenal diverticulum is a rare differential diagnosis of pain in the upper abdomen. The diverticulum should be endoscopically removed if other causes for abdominal pain have been ruled out and possibly associated malformations have been excluded.

[Posthepatic icterus caused by a solitary granular cell tumor of the common bile duct]. / Posthepatischer Ikterus durch einen solitären Granularzelltumor des Ductus choledochus.

We report a case of a 26-year-old female patient who was referred to our hospital with a painless jaundice. By means of an ERCP we found a nearly complete occlusion of the common bile duct caused by a tumor. After stenting and normalization of the cholestasis parameters, additional investigations such as endosonography, cholangioscopy and MR angiography no longer showed any manifestation of the tumor. The histological and cytological specimens did not confirm a malignant process. As there was apparently only a solitary tumor a resection according to Whipple was performed. The histological examination showed a granular cell tumor. This case report demonstrates that a posthepatic icterus may rarely be caused by a granular cell tumor. Furthermore, it clearly shows the difficulty to correctly diagnose a tumor in the extrahepatic common bile duct as one may often have to rely solely on imaging procedures.

[Amoxicillin/clavulanic acid in therapy of bacterial infections of the diabetic foot. Results of an observational study]. / Amoxicillin/Clavulansäure in der Therapie des bakteriell infizierten diabetischen Fusses. Ergebnisse einer Anwendungsbeobachtung.

The results of an observational study of amoxicillin/clavulanic acid (Augmentan) in 191 patients are presented. The average duration of treatment was 15 days (median). Healing or improvement was observed in 76% of the cases. In view of the fact that the condition often has a multifactorial genesis and neural and vascular changes impair healing, this result must be considered a clinical success. Variables with an influence on the efficacy of the treatment were the incidence of manifestation and pathogenesis of the ulcer, renal function, blood pressure and smoking. Amoxicillin/clavulanic acid was well tolerated, with adverse events being observed in only 9 out of 193 patients (4.7%). Treatment was abandoned because of adverse events in 3 out of 193 patients (1.6%). Overall, treatment of the infected diabetic foot with amoxicillin/clavulanic acid was well tolerated and effective.

[Toxic liver damage caused by HMG-CoA reductase inhibitor]. / Toxischer Leberschaden durch HMG-CoA-Reduktase-Hemmer.

CASE REPORTS: We report on 4 patients who were referred to the clinic with suspected acute hepatitis and to investigate high transaminase values. After exclusion of specific hepatitis, unspecific virus hepatitis, autoimmune hepatitis, a metabolic disorder damaging the liver and extrahepatic cholestasis, a toxic liver damage remained as the probable cause and was histologically verified. Since other drugs and alcoholics could be eliminated as possible causes of the damage, the toxicity had to be attributed to statin ingestion. CLINICAL COURSE: After discontinuation of the medication with continuation of all other therapeutic agents of the general practitioners, the transaminase values normalized within a few weeks. Renewed administration of statin was not prescribed for ethical reasons. CONCLUSION: Therefore, when prescribing a HMG-CoA-reductase inhibitor, the possibility of liver damage should be mentioned and regular checks of the transaminase values should be performed.

[Therapy of bronchitis. Successful single-dosage treatment with N-acetylcysteine, results of an administration surveillance study in 3,076 patients]. / Therapie der Bronchitis. Erfolgreiche Behandlung mit N-Acetylcystein als Einmalgabe, Ergebnisse einer Anwendungsbeobachtung bei 3,076 Patienten.

UNLABELLED: The efficacy and safety of N-acetylcysteine prescribed in general practice were investigated. METHOD: open, non-controlled surveillance study conducted at 744 centers. PATIENTS: 3,076 patients suffering from bronchitis. MEDICATION: 600 mg N-acetylcysteine (Fluimucil-Long, Inpharzam Germany), administered as a single daily dose. END POINTS: evaluation of coughing, amount and quality of sputum, expectoration, dyspnea, compliance and tolerance. RESULTS: impressive improvement of the symptom complex, good compliance. Adverse reactions were reported in 45 patients (rate: 1.5%). CONCLUSIONS: treatment of chronic and acute bronchitis with the mucolytic agent N-acetylcysteine administered once daily, proved to be both effective and well tolerated.