Exacerbation of lichen planus during interferon alfa-2a therapy for chronic active hepatitis C.

A 66-year-old man was treated for chronic active hepatitis C with 3 MU of recombinant interferon alfa-2a three times weekly. Nine months before interferon therapy, a mild lichen planus had been diagnosed, which exacerbated within 4 weeks of treatment to a generalized erosive lichen planus. After 8 weeks, interferon therapy was stopped because local measures did not improve skin lesions. Otherwise, the patient tolerated interferon therapy well, and the initially 20-fold elevated aminotransferase levels returned to normal. Four weeks after discontinuation of interferon therapy, nearly all mucosal and skin lesions had disappeared. But 8 weeks after the discontinuation, aminotransferase levels again rose to 10 times the normal range. Treating physicians should know that a preexisting lichen planus will potentially exacerbate as a side effect of interferon alfa-2a therapy of a chronic hepatitis. However, because this is the first report on this association, further observations are needed to decide the clinical relevance.

[Therapy of stomach ulcer--a comparison between the low dosage antacid hydrotalcite and ranitidine--results of a randomized multicenter double-blind study. Talcivent Study Group]. / Therapie des Ulcus ventriculi--Ein Vergleich zwischen dem niedrig dosierten Antazidum Hydrotalcit und Ranitidin--Ergebnisse einer randomisierten multizentrischen Doppelblindstudie. Talcivent Studiengruppe.

In a 8 week double-blind randomized multicenter trial in 159 patients with benign gastric ulcer the efficacy of hydrotalcite vs. ranitidine in expediting ulcer healing and in achieving pain relief was determined. 79 patients received hydrotalcite 1000 mg q.i.d. as tablets equalling a total neutralizing capacity of 111.2 mval and 80 patients received ranitidine (300 mg at night). Endoscopically controlled healing rates after 4 weeks of therapy amounted to 41.8% with hydrotalcite and 53.8% with ranitidine. After 8 weeks both regimen showed significant equivalent healing rates (hydrotalcite: 81.0%, ranitidine: 78.8%, p < 0.003). Ulcer pain decreased parallel in both groups. By the end of therapy 92.4% of the patients treated with hydrotalcite and 86.3% of those receiving ranitidine were free of pain. Incidence of helicobacter pylori in antral mucosal biopsies was not influenced by both treatments. We conclude that an 8-week treatment with low dose hydrotalcite therapy is as effective as ranitidine in healing benign gastric ulcers and achieving pain relief.

[Real-time sonography in deep thrombosis of the pelvic and leg veins. A prospective comparison to phlebography]. / Real-time-Sonographie bei tiefer Becken- und Beinvenenthrombose. Ein prospektiver Vergleich zur Phlebographie.

Real-time B mode ultrasound is a well accepted diagnostic procedure in the non-invasive vascular examination. In a prospective study we examined 101 patients with clinical suspected deep vein thrombosis of the pelvis or leg using ultrasound and contrast venography within 24 hours and we compared the results of both examinations. All veins of the pelvis and lower extremities were scanned in transverse and longitudinal planes. 113 venograms were obtained; they demonstrated the presence of isolated proximal vein thrombosis in seven patients, seven isolated calf vein thromboses and 43 thromboses of both proximal and calf veins. The sensitivity of ultrasonography for detecting deep vein thrombosis in the proximal veins of the lower extremity was 98%, the specificity was also 98%. In the veins of the pelvis the sensitivity was 78%, the specificity 98% and in calf veins 60% and 97% respectively. The sensitivity for the detection of isolated calf vein thrombosis was only 14%. We conclude that ultrasonography has a very good sensitivity for detecting proximal vein thrombosis of the lower extremity and thrombosis of the pelvic veins. Phlebography remains the better method in detecting isolated calf vein thrombosis because of the difficult visualisation of the small calf veins by ultrasonography.

[Soft skin fibromas: study of their importance and diagnostic significance for colonic neoplasms]. / Weiche Hautfibrome: Untersuchung ihrer Einflussgrössen und ihrer diagnostischen Bedeutung für Kolonneoplasien.

The aims of this study were (a) to examine the association of skin tags and colonic polyps and (b) to identify factors influencing skin tags. Therefore, a consecutive series of 157 medical ward patients with gastrointestinal symptoms who underwent colonoscopy underwent dermatological examination. Skin tags were found in 52% of these patients regardless of sex. (a) There was a statistically significant association between skin tags and colonic polyps (P = 0.33). This association, however, was based solely on an age effect. (b) Influencing factors were weight and age for the number of skin tags and the interaction between sex and the concentration of triglycerides for their size. At any given triglyceride concentration, men had larger skin tags.

[The association of skin fibromas and intestinal polyps: an age-related effect]. / Assoziation von Hautfibromen und Darmpolypen: ein Alterseffekt.

To test the association between skin tags and colorectal polyps, 157 consecutive patients (60 men and 97 women, mean age 61.2 [17-92] years) who during their hospitalization had a coloscopy for gastro-enterological indications, underwent independently medical and dermatological examinations. 61 patients (38%) had colorectal polyps, 83 (53%) skin tags; 39 had both (24.8%). Thus the probability of having colorectal polyps was significantly higher for a person with than without skin tags (P = 0.033). But this relationship was entirely age-dependent. Discriminant analysis indicated that in addition to age (F = 15.1) the presence of skin tags (F = 1.2) was only a small additional factor in the recognition of those with colorectal polyps. Skin tags are thus of little help in the diagnosis of polyps in elderly patients.

[Colonic neoplasms and skin fibromas: common determinants and their significance]. / Kolonneoplasien und Hautfibrome: Gemeinsame Einflussgrössen und deren Bedeutung.

To find common factors for colonic-neoplasias and skin-tags, 157 inpatients, who consecutively had a coloscopy because of intestinal complaints, were intensively examined dermatologically. Regression-analyses showed that the number of colonic polyps were age- (p = 3 x 10(-8)) and sex-dependent (1.9 x 10(-2)) and skin-tags had no influence on the number of colonic polyps. The size of colonic polyps also showed a clear age dependency (p = 3 x 10(-8)). The number of skin-tags were dependent on weight (p = 9 x 10(-3)) and age (p = 1.3 x 10(-2)), its size on the interaction of sex and triglyceride-levels (p = 3 x 10(-8)). Discriminant-analyses identified the following factors as important: age and triglyceride-concentration to recognize a patient with colonic polyps; age, positive Haemoccult-test and number of skin-tags to recognize a patient with tubulovillous adenomas or colonic carcinomas. The essential common factor of colonic polyps and skin-tags was the age. For the recognition of a patient with colonic polyps the age was the most essential factor, skin-tags, on the contrary, were unimportant. The association between colonic polyps and skin-tags therefore was merely an effect of age.

[Inappropriate ADH secretion caused by alcohol withdrawal: a rare cause of hyponatremia]. / Syndrom der inadäquaten ADH-Sekretion durch Alkoholentzug. Eine seltene Ursache der Hyponatriämie.

A 52-year-old man, known to be alcohol dependent, was admitted to hospital because of intense drowsiness. He had previously drunk over 100 g alcohol daily, but for the last 2 days "not a drop". Serum sodium concentration was 103 mmol/l, serum osmolarity was low (216 mosmol/l) and urine osmolarity remarkably high (373 mosmol/l). These abnormalities, taken in conjunction with his normal water balance (absence of obvious edema or dehydration), suggested the diagnosis of inappropriate secretion of antidiuretic hormone (ADH), and this was confirmed by a water loading test. Exclusion of the recognized causes of inappropriate ADH secretion left alcohol withdrawal as the only tenable explanation. The reabsorption of water which it induced was the cause of the patient's hyponatraemia and drowsiness. Restriction of fluid intake to 500 ml daily with continued total abstinence from alcohol led to rapid recovery. The discovery of hyponatraemia in an alcoholic in a state of normal water balance should rouse suspicion of inappropriate ADH secretion.

[Sonographic findings in silicone-induced granulomas and lymphadenopathy following mammaplastic surgery]. / Sonographische Befunde bei silikoninduzierten Granulomen und Lymphadenopathie nach plastischer Mammachirurgie.

Ultrasound examination of the breast and its lymphatic drainage was undertaken in 78 patients who--after mammoplasty with silicone implants--had palpable lymph nodes, pain and sensation of tension in the area surrounding the implant. Five patients had space-occupying echo-dense inner structures and dense echos from structures dorsal to the space-occupying ones. In this way silicone granuloma could be demonstrated even preoperatively in tissues, musculature or lymph nodes, although the changes were palpable in only two of the five patients. Ultrasonography can thus be of great importance not only in the diagnosis but also in the preoperative localization of silicone-induced granulomas.

[A new latex agglutination test for the immunologic detection of occult blood in stool]. / Ein neuer Latex-Agglutinationstest zum immunologischen Nachweis von okkultem Blut im Stuhl.

An new latex agglutination system was developed for the detection of occult blood in the feces. Antibodies against human hemoglobin were raised in a goat. Blood in concentrations of 0.1 ml-8.0 ml/100 g feces were detected in vitro. The antibodies were separated and adsorbed to latex particles (0.3 microns). After in vitro standardisation of the new test system we compared the efficacy of the commonly used guaiac slide test for detection of occult blood in the stool (hemoccult-test) with the latex test system. A significant higher sensitivity could be reached with the latex test system. In a clinical study 61 patients were tested. In 31 of them occult blood was found with the latex test system while with the guaiac slide-test system no blood was detected using the same stool specimen. 13 of the 31 patients had a neoplastic lesion of the colon - 4 a colon carcinoma and 9 had adenomatous polyps of the large bowel larger than 5 mm in diameter. In the remaining patients the sources of intestinal bleeding were: upper gastro-intestinal bleeding sources in 8 patients and other colonic bleeding sources like diverticular disease, inflammatory bowel disease, hemorrhoids and a rectal ulcer in 8 patients. In 2 of the 61 patients the latex test was positive without endoscopic significance for the bleeding source.

[Endoscopic implantation of a gastric balloon--a method of weight reduction with few complications?]. / Endoskopische Implantation eines Magenballons--ein komplikationsarmes Verfahren zur Gewichtsreduktion?

A gastric balloon was endoscopically implanted in seven over-weight (36-58%) patients to achieve weight reduction on an out-patient basis. During the period of observation four patients spontaneously passed the balloon transanally, one after brief intestinal obstruction with abdominal cramps and vomiting, another with the development of ileus, which responded to eight days of conservative treatment. The occurrence of such not insignificant side effects suggests that at present the use of endoscopic implantation of gastric balloons is not a reasonable way of treating obesity.

[Bacterial hemoglobin degradation in feces--the cause of false-negative occult blood tests. Results of an in vitro study]. / Bakterieller Hämoglobinabbau im Stuhl--Ursache falsch negativer Okkultblut-Tests. Ergebnisse einer In-vitro-Studie.

Possible causes of false negative tests for occult fecal bleeding are hemoglobin concentrations too low to be detected or a bacterial degradation of fecal hemoglobin. In the present in vitro study the degradation of hemoglobin was assessed in cultures of fecal bacteria or in homogenates of human feces. At a hemoglobin concentration of 1.5 mg per gram stool a 48 h incubation caused a decrease of test positivity for hemoglobin of 88% (aerobic conditions) or 52% (anaerobic conditions). Thus, bacterial degradation is one of the causes of false negative test results when testing for occult fecal bleeding. These findings should be considered by the clinician when the efficiency of currently available occult blood tests in detecting right sided colonic lesions is to be assessed.

[Sodium content of liquid antacid preparations]. / Natriumgehalt flüssiger Antacidum-Präparate.

The sodium content of 13 liquid antacids was determined using two independent analytical methods (flame photometry). With a neutralisation buffering capacity of 564 mmol/d (pH 3.5) the possible body sodium load was calculated by evaluating the sodium content in the supernatant of the antacid suspensions, ranging from 0.56 to 568 mmol/d (method A) and from 0.42 to 468 mmol/d (method B). Therefore, in patients who are on a sodium restriction of 50 mmol/d this critical intake may be easily exceeded by the intake of certain antacids.

Measurement of resistance of barriers to solute transport in vivo in rat jejunum.

Assessment of intestinal absorptive function requires techniques for correcting transport constants for diffusion barrier resistance. These studies were done to develop such techniques for use in vivo. In one method the functional thickness of the unstirred water layer (d) in rat jejunum was quantitated electrically, and its minimal surface area (Sw) was measured directly. From these values the diffusion barrier resistance (d/Sw) decreased from 0.041 to 0.022 as the perfusion rate of the intestine was increased from 1.5 to 15 ml/min. In the second method apparent passive permeability coefficients (*P) were measured for a series of saturated fatty acids, and these increased with chain length. However, at the longest chain lengths tested, *P became proportional to their free diffusion coefficients, indicating that uptake was limited by the rate of diffusion up to the microvillus surface. From the rates of uptake of such diffusion-limited probes, the diffusion barrier resistance was again calculated and found to decrease from 0.041 to 0.022 as the rate of perfusion was increased from 1.5 to 15 ml/min. Over this same range of perfusion rates, the apparent Michaelis constant (*Km) for D-glucose transport decreased from 18.2 to 10.0 mM. Using either set of resistance terms and these apparent Km values, the true Km value for glucose transport in vivo was found to equal 0.8 mM when the barrier resistance was extrapolated to zero. Thus these data indicate that diffusion-limited probes can be utilized to measure unstirred layer resistance in the intestine of a live animal so that absolute transport parameters can be determined in vivo in experimental animals and, presumably, in humans.

[Primary cancer of the vermiform appendix--case report and literature review]. / Primäres Karzinom der Appendix vermiformis--Fallbericht und Literaturübersicht.

The case history of an eighty one year old white male with progressive cachexia and massive ascites is given. Autopsy revealed the rare finding of a primary adenocarcinoma of the appendix with multiple metastases as the cause of the rapidly deteriorating clinical condition. The incidence, clinical findings and therapeutic options in carcinoma of the appendix are discusses based on a review of the literature.

[Effect of somatostatin on hypercalcemia stimulated gastric juice and exocrine pancreas secretion in the human]. / Effekt von Somatostatin auf die durch Hyperkalzämie stimulierte Magensaft- und exokrine Pankreassekretion beim Menschen.

Hypercalcemia produced in healthy volunteers by intravenous infusions of calciumgluconolactobionate increased outputs of gastric acid, pepsin, and pancreatic enzymes. Hypercalcemia did not affect gallbladder emptying and serum gastrin values. Further, intravenous somatostatin (SRIF, 5 micrograms/kg.h) markedly inhibited secretion of gastric acid (p less than 0.01), pepsin (p less than 0.05), and pancreatic enzymes (p less than 0.02) stimulated by hypercalcemia. SRIF-inhibited outputs were below basal values. These results indicate that the inhibitory effect of SRIF on exocrine cells of the human gastrointestinal tract can not be reversed by extracellular hypercalcemia.

[Therapy of stomach ulcer with low-dose antacid gel and cimetidine. A multicenter double-blind study]. / Therapie des Ulcus ventriculi mit niedrig dosiertem Antacidumgel und Cimetidin. Eine multizentrische Doppelblindstudie.

In a multi-centre double-blind (double-dummy) trial the effectiveness of low-dose antacid gel (6 X 12 ml/d; neutralisation capacity 120 mmol) was compared with that of a standard dose of cimetidine (1 g/d) in the curative treatment of gastric ulcer. Antacid gel was given to 65 patients, cimetidine to 60. Diagnosis was confirmed by endoscopic biopsy, which was also employed in a serial follow-up. After 4 weeks antacid gel and cimetidine produced cures in 43% and 52%, respectively; after 8 weeks 76% and 89%, respectively, the difference between the two methods not being statistically significant. There was also no statistically significant difference with regard to ulcer pain. In one case each in the antacid and cimetidine groups, the treatment had to be stopped because of side effects. Diarrhoea was more common on cimetidine than on antacid gel. It is concluded that both low-dose antacids gels and cimetidine are suitable in the treatment of gastric ulcers.

European Cooperative Crohn's Disease Study (ECCDS): clinical features and natural history.

In the European Cooperative Crohn's Disease Study patients from 14 centers were included in whom diagnosis was made within 2 years before study entry on the basis of generally accepted radiological, endoscopical and/or histological criteria or a combination of all. Reasons for exclusion were: diagnosis older than 2 years in patients who did not require active treatment, age less than 18 years, duration of symptoms less than 3 months, presence of complications which potentially required emergency surgery. Data on clinical features were obtained in 633 patients, of whom 452 were eligible to participate in the study. In 110 patients randomized to placebo the natural course of Crohn's disease was studied. Patients with ileocolonic involvement were younger than patients with either colonic or small intestinal involvement only. Classic ileitis terminalis was present in 14% of the patients. 49% of the patients had combined involvement of both the small and large intestine. 30% of patients had only small intestinal involvement, and in 21% colonic disease was present. Small intestinal involvement was associated with a significantly lower Crohn's Disease Activity Index (CDAI) than other anatomical locations of the disease. Perianal disease was more often associated with colonic than with small intestinal involvement. 60% of placebo patients with active disease at entry achieved at least a transient remission within the initial 5 months of study. After 2 years, 23% of patients with active disease at entry and 68% of patients with quiescent disease had reached or maintained a remission, respectively. By stepwise multiple linear regression analysis long duration of disease between diagnosis and randomization, normal serum albumin and combined involvement of small intestine and colon were identified as predictors of a more favorable outcome of patients treated with placebo. In contrast, extensive small bowel disease, treatment with steroids and bowel resection prior to study entry correlated with a less favorable outcome. However, by life table analysis outcome of previously untreated and treated patients in the placebo group was similar.

[Postvagotomy complications: stomach bezoars - case report and review of the literature]. / Postvagotomiekomplikation: Magenbezoare - Fallbericht und Literaturübersicht.

A 59 year old female with multiple gastric surgical procedures (Billroth I and Billroth II) for recurring ulcer disease developed a gastric phytobezoar following an additional truncular vagotomy within 2 months. Already 1 month after complete endoscopic removal the phytobezoar recurred in spite of dietary restrictions. The phytobezoar was successfully dissolved by oral Cellulase-therapy. The truncular vagotomy and its influence on gastric motility has to be considered as the cause of the repeated bezoar formation.