[Clubbed fingers in a case of low-malignancy leiomyosarcoma and mixed-type hiatal hernia]. / Trommelschlegelfinger bei einem niedrig malignen Leiomyosarkom mit gemischter Hiatushernie.

HISTORY AND CLINICAL FINDINGS: The husband of a 33-year-old woman had noticed clubbing of her finger nails. She herself reported frequent gastric reflux symptoms. Admission findings were unremarkable except for finger clubbing. INVESTIGATIONS: Erythrocyte sedimentation rate (ESR) was raised to 23/68 and she had a hypochromic iron-deficiency anaemia (haemoglobin 11.1 g/dl, RBC count 4.24 x 10(6)/microliters, iron concentration 31 micrograms/dl, ferritin 15.2 micrograms/dl) and an increase in platelets (431 x 10(3)/microliters). Chest radiogram showed a retrocardiac dense and round shadow, 10 cm in diameter, which on abdominal sonography was an echo-poor structure that could be traced far cranial. Gastroscopy and double-contrast radiology of the stomach revealed a 14 cm long hiatal hernia of mixed type and a submucous tumour in the anterior wall, which on computed tomography was a 6 cm subcardiac tumour, the stomach lying largely within the chest. TREATMENT AND COURSE: At surgery the stomach was intrathoracic except for a short antral portion. Because of the size of the tumour, 15.10 cm, a gastrectomy was performed. Histologically it was a leiomyosarcoma of low malignancy. Postoperatively the ESR fell to 12/28 mm and the anaemia regressed (haemoglobin 13.5 g/dl, RBC 4.95 x 10(6)/microliters). Two years later there was no sign of local tumour recurrence and the finger clubbing had largely disappeared. CONCLUSION: Recently developed finger clubbing should always be an indication for further investigation. In addition to the wellknown cardiopulmonary diseases, one of a number of other treatable causes may be responsible. Research of literature revealed no comparable case.

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.

[Application and fixation systems in enteral nutrition]. / Applikations- und Fixationssysteme der enteralen Ernährung.

Enteral nutrition is becoming more convenient because of a lot of available different techniques. Tubes can be placed nasogastrically, nasoduodenally or nasojejunally, as bedside method controlled by X-ray or with the aid of an endoscope. If there is a risk of spontaneous removal, fixing with a stabilisation system is helpful. In cases where the tube should be hidden, a specially prepared plastic olive placed in the nostril can be used. All these methods are of interest for short and medium term enteral nutrition. For long term enteral nutrition, the percutaneous endoscopic gastrostomy, especially the so-called 'thread-pass-through' method is increasingly in use. All attempts to arrange a simpler method using direct punction techniques have failed up to now. The following paper gives a survey of different technical possibilities.

[Adenomatosis of the bile ducts as a rare cause of cholestasis]. / Adenomatose der Gallenwege als seltene Ursache einer Cholestase.

Biliary obstruction of uncertain aetiology in a 69-year-old women led to a cholecystectomy and exploration of the bile tract: a nearly complete cast of the hepatic ducts and intrahepatic bile ducts was extracted. Histological examination of the gall bladder and liver biopsy failed to provide a diagnosis, but a bile duct biopsy taken at the time of an endoscopic retrograde cholangiography revealed the diagnosis of papillomatosis. This disease has a poor prognosis because there is no known cure.

[Use of a stabilization system for fixation of enteral feeding tubes. Comparative study]. / Anwendung eines Stabilisationssystems zur Fixation von Ernährungssonden. Vergleichende Untersuchung.

Inadvertant tube dislodgement is a problem in confused patients. In 100 consecutive patients feeding-tubes were placed and secured with adhesive tape or use of a stabilization system. Duration of placement was significantly different in the 2 groups (tape-fixation 6.7 +/- 0.8 days, stabilization system 17.9 +/- 2.7 days; p less than 0.01). Inadvertant dislodgement could not be prevented completely but the stabilization system seems to be a simple alternative compared to invasive technics.

[Adjuvant therapy with elemental diet in chronic inflammatory intestinal diseases. Comparative study]. / Adjuvante Therapie mit Formeldiäten bei chronisch-entzündlichen Darmerkrankungen. Vergleichende Untersuchung.

26 in-patients (17 with Crohn's disease, 9 with ulcerative colitis) were given high-molecular (diet 1; 12 patients) or low-molecular (diet 2; 14 patients) elemental diets (6.3-12.6 MJ) additional to drug treatment previously given as out-patients. The activity index fell on both diets (on diet 1 from 253 to 83; diet 2 from 259 to 86), stool frequency decreased (on diet 1 from 7.1 to 0.9 per day; diet 2 from 5.6 to 2.0 per day), as did blood sedimentation rate (diet 1 from 57/80 to 30/51 mm; diet 2 from 56/80 to 23/45 mm). Body-weight, total protein, albumin and red blood corpuscles were not changed significantly. There was no significant difference between the two diet groups. The results raise the question of whether low-molecular elemental diet enriches the treatment of chronic inflammatory disease.

Simultaneous endoscopic and radiologic examination of the colon.

The selective radiologic visualization of pathologic ileocolonoscopic findings using contrast medium offers various advantages over endoscopy or radiologic evaluation performed alone. It allows one to combine a macroscopic biopsy with the radiologic examination and documentation procedure. The technique proves useful to document benign and malignant stenoses and tumors of the colon, diverticular disease, and mucosal abnormalities in long-standing ulcerative colitis and Crohn's disease, and to visualize fistulae, the appendix, or terminal ileum. Up to now, 146 patients have been examined without complication.