The correlation between magnetic resonance imaging and the operative and clinical findings after lumbar microdiscectomy.

Fifty-four consecutive patients were studied prospectively with magnetic resonance imaging before microdiscectomy, and the findings correlated with clinical symptoms before and after operation. A sequestrated fragment was found in 59% of cases, a subligamentous disc sequestration in 25% and a disc protrusion in 16%. The levels operated on were L4/5-36%, L5/S1-62.5%, and one at L3/4; 71% were laterally placed, 10% lay intraforaminal and 10% medial. The diameter of the protrusion was 4 mm to 13 mm for the craniocaudal extension, and 5 mm to 18 mm for the anteroposterior extension. No correlation could be found between a neurological deficit and the size of the prolapse. A positive correlation was present between the increasing degree of canal obstruction and the degree of disc degeneration determined by imaging for extrusions, subligamentous disc sequestrations and free sequestrations. Nerve root inflammation and enlargement was seen in 36% of the images, corresponding to an operative finding of 32%. Magnetic resonance imaging is a helpful pre-operative diagnostic investigation which shows structural changes in the disc and the correct localisation and size of the disc sequestration, but there was no correlation between the imaging findings and the clinical symptoms.

[Results of surgical therapy of ruptures of the rotator cuff of the shoulder]. / Ergebnisse der operativen Therapie von Rupturen der Rotatorenmanschette der Schulter.

OBJECTIVE: This retrospective study was designed to evaluate mid-term results of patients after surgical treatment of rotator-cuff-tears by means of clinical and ultrasonographical examination with special regard to factors influencing the prognosis. METHOD: 126 patients were examined clinically and ultrasonographically at a mean postoperative period of 37 months after surgery for rotator cuff lesions. A conservative therapy failed to be successful for at least 3 months before. All patients received an open decompression of the subacromial space, 68.6% of the patients received an additional reconstruction of the rotator cuff. The results were evaluated by use of the Constant-Score. The ultrasonographical examination was performed according to the technique described by Hedtmann. RESULTS: 69% of the patients showed good and excellent results. The mean Constant-Score was 81.4% of the age- and sex-related normal values. Patients with lesions extending more than 3 cm did significantly worse than those with smaller ruptures (Constant-Score: 74.2% vs. 90.6%). An involvement of the subscapularis-tendon was related with bad results. A rerupture was seen ultrasonographically in 17.3% of the patients. CONCLUSION: Regarding strict criteria of evaluation almost 70% of our patients not responding to conservative treatment achieved good and excellent results after surgery. Smaller lesions and tears solely involving the supraspinatus-tendon were associated with a better prognosis. Ultrasonography allows a reliable examination of the rotator-cuff-anatomy postoperatively performed, too.

Efficacy and tolerability of a one-week triple therapy consisting of pantoprazole, clarithromycin and amoxycillin for cure of Helicobacter pylori infection in patients with duodenal ulcer.

BACKGROUND: Previous studies have shown that one-week triple therapy consisting of omeprazole, clarithromycin and amoxycillin may cure Helicobacter pylori infection in the vast majority of patients. The present study was designed to test the hypothesis that a triple therapy with pantoprazole, clarithromycin and amoxycillin cures the infection in > or = 80% of duodenal ulcer patients infected with H. pylori. METHODS: In an open two-centre study, 60 duodenal ulcer patients were treated with pantoprazole 40 mg b.d., clarithromycin 500 mg b.d. and amoxycillin 1 g b.d. for 1 week. During the second week patients received pantoprazole 40 mg once in the morning. We assessed H. pylori infection before treatment and 4 weeks after cessation of the study medication by a rapid urease test, histology after Warthin-Starry stain and a 13C-urea breath test. RESULTS: Sixty patients (42 males, mean age 47.4 years) entered the trial. All patients were infected with H. pylori. One patient was withdrawn from the study because of allergy to penicillin and six patients were protocol violators. H. pylori infection was cured in 47 out of 53 patients who completed the trial according to the protocol (89%; 95% CI: 80-97%) and in 49 of 60 patients included in the trial (82%; 95% CI: 72-92%). Four weeks after the last administration of study drugs, 55 out of 60 ulcers had healed (92%). Twenty-nine patients reported 51 adverse events that were mostly mild to moderate. CONCLUSIONS: One-week triple therapy consisting of pantoprazole, clarithromycin and amoxycillin is a simple and effective approach to the cure of H. pylori infection in patients with duodenal ulcer. In those patients who took the drugs as prescribed the H. pylori cure rate was 89%, with the lower 95% confidence limit being 80%.

Observation of gastric glandular cysts in the corpus mucosa of the stomach under omeprazole treatment.

In patients undergoing long-term treatment with omeprazole, tiny gastric polyps, described histologically as glandular cysts, have occasionally been reported. We report on a further nine patients (5 women and 4 men) undergoing omeprazole treatment who developed endoscopically visible and histologically verified glandular cysts. Eight patients were on long-term treatment with omeprazole for reflux oesophagitis, and the glandular cysts were observed between 8 and 60 months after the start of treatment. In one patient with an NSAID-induced ulcer, a tiny polyp was found only three weeks after initiation of treatment. None of the patients had Helicobacter pylori-associated gastritis. The cysts, which measured between 0.25 and 0.7 mm in diameter, were mostly lined with flattened parietal and chief cells, but in three cases also with foveolar epithelium, so that they could not be reliably distinguished from Elster's gastric glandular cysts. These glandular cysts are harmless, and do not require further diagnostic or therapeutic measures. They probably develop spontaneously independently of the omeprazole therapy.

Intrathoracic dural ectasia mimicking neurofibroma and scoliosis. A case report.

Angular thoracic scoliosis combined with dural ectasia and foraminal enlargement is reported in a patient with neurofibromatosis. The dural cyst was resected through a high thoracic approach and the scoliosis dealt with by posterior spinal fixation with Modulock instrumentation. Follow up after 12 months showed no neurological deficit and no progress of the scoliosis.

[Endoscopic biopsy diagnosis of malignant lymphoma of the stomach and early stomach lymphoma]. / Endoskopisch-bioptische Diagnostik des malignen Lymphoms des Magens und des Magenfrühlymphoms.

From 1978 to 1988 a malignant lymphoma of the stomach was diagnosed endoscopic-bioptically in 47 patients. In 41 patients it was a primary gastric lymphoma, in 6 a generalized lymphoma. In 20 cases an advanced gastric lymphoma was present which was diagnosed endoscopic-bioptically without problems. In 27 cases, however, lymphomas showed polymorphous lesions which did not look tumorous. In such cases the lymphomas were found in an early stage and bioptic verification was difficult. On an average three bioptic series were needed for histological proof. In 16 lymphomas of this group the malignant infiltration was limited to mucosa/submucosa on operative resection specimens ("early gastric lymphomas") The endoscopic appearance of these early lymphomas was: thickening mucosa-folds (2 cases), extended areas of "regenerative mucosa" and granular pattern (6 cases), mainly multiple irregular ulcerations (8 cases). The above mentioned endoscopic findings are strongly suspected for an early gastric lymphoma and should be clarified by, if needed repeated, bioptic series.

[What does laparoscopy contribute to explaining fever of unknown origin?]. / Was leistet die Laparoskopie bei der Klärung von Fieber unbekannter Ursache?

The diagnostic value of laparoscopy with biopsy under vision was analysed retrospectively in 70 patients with persisting or recurrent fever of at least six weeks' duration which had remained unexplained despite detailed noninvasive studies. In 42 of these patients an intra-abdominal process had been suspected. The cause of fever was directly or indirectly diagnosed by the laparoscopy in 31 patients (44%), 29 of whom had clinical findings or abnormal biochemical results pointing to an involvement of abdominal organs. The most common laparoscopic diagnosis was granulomatous disease, isolated liver disease or malignant lymphoma. If clinical signs pointing to abdominal involvement are absent, laparoscopy is unlikely to aid in the diagnosis of fever of unknown origin.

Palliative treatment of inoperable patients with carcinoma of the cardia region.

Endoscopic palliative treatment of inoperable patients with carcinoma of the cardia region is superior to surgical procedures that allow the feeding of patients. After dilating the malignant stenosis with an Eder-Puestow dilator, a Celestin or Atkinson tube is inserted endoscopically by means of the Nottingham introducer. In 25 of 26 patients the inserted tube functioned well until the death of the patient for an average of 109 days. Six patients are still alive and one patient has had the tube for almost 3 years. Of the 19 patients who died, 18 retained the tube until they died. The complication rate of the procedure was 11.5% with a 3.8% mortality related to tube insertion.

[Recurrent fever of unknown etiology lasting more than 6 months. Report on 85 patients]. / Uber 6 Monate bestehendes rezidivierendes Fieber ungeklärter Ursache. Bericht über 85 Patienten.

85 patients having recurrent fever of unclarified aetiology of more than 38.5 degrees C for more than 6 months were examined in a prospective study. Of these, 10 had an inflammation due to pathogens, 12 a malignant disease, 15 a collagenous or inflammatory vascular disease, while 9 had various diseases, 5 a familial Mediterranean fever and 18 a "periodic fever". In 16 patients, in most of whom the course of the disease extended over several years, the cause of the fever could not be clarified. Among the patients with polycyclic fever over many years or decades, alternating with symptom-free intervals, one can differentiate especially the systemic Still's syndrome, which also occurs in adults and which is identical with the so-called subsepsis allergica, the familial Mediterranean fever and the "periodic fever". There are no satisfactory pointers towards the existence of a relapsing fever of its own caused by an increase of unconjugated aetiocholanolone in the plasma ("aetiocholanolone fever").