[A modified monopolar electrocoagulation probe for endoscopic treatment of gastrointestinal hemorrhage]. / Eine modifizierte monopolare Elektrokoagulationssonde zur endoskopischen Behandlung gastrointestinaler Blutungen.

A modified monopolar electrocoagulation probe for endoscopic treatment of gastrointestinal bleedings in special situations is described. The tip of the active electrode may be moved foreward or drawn back into a teflon catheter. Thereby, blood clots are removed from the tip of the probe. The device is easy to use, reliable in emergency endoscopies and can be employed with conventional high-frequency diathermy instruments. The probe is inexpensive. 49 patients with active gastrointestinal bleedings according to Forrest Ib were treated. In 40/49 patients permanent hemostasis could be achieved. In 4/49 patients recurrent bleedings were controlled after repeated electro-coagulation. 4/49 patients needed elective operation, one patient emergency operation. Complications by application of the described monopolar electrocoagulation probe did not occur. The area of necrosis according to electrocoagulation was small.

[Endoscopic control of balloon dilatation of the pylorus]. / Endoskopisch geführte Ballondilatation des Pylorus.

After resection of a cardia carcinoma a gastric obstruction was observed. Because of a severe esophagitis the planned operation could not be performed. In the following a method of palliative treatment of pyloric dysfunction is described. Under fluoroscopic control a stiff balloon catheter was introduced into the stomach. Under endoscopic control a guide wire fitting the central lumen of the balloon catheter was passed into the pylorus by use of a biopsy forceps. Under endoscopic and fluoroscopic control the guide wire was positioned in the duodenum. Than the balloon catheter was passed through the pylorus both, under endoscopic and fluoroscopic control and inflated. No complication was observed. After dilatation of pylorus the patient was able to take food as usual. In the following weeks the esophagitis was treated and the pyloroplasty was performed successfully.

[Pathogenesis of hereditary angioedema]. / Pathogenese des hereditären Angioödems (HAE).

The hereditary angioedema (HAE) is an autosomal dominant transduced illness. Patients suffer from severe attacks with circumscribed swellings of the skin, or of the gastro-intestinal mucosa, or of whole organs. Laryngeal edema is responsible for airway obstruction and often for sudden death. Very often the abdominal symptoms are leading to false diagnosis and treatment. The diagnosis is proved by estimation of lowered C1-inhibitor (C1-INH) activity. The defect of C1-INH is responsible for the activation of the start phases of the complement system and of the kinin system. The liberation of vasoactive peptides and kinins induces the edematous swellings and severe pain. The acute symptoms of HAE are promptly resolved by intravenous application of C1-inhibitor concentrate.

A modified monopolar polypectomy snare for endoscopic high-frequency surgery in the gastrointestinal tract.

A modified instrument for endoscopic polypectomy is presented. The tip of the monopolar electrode is coated with a teflon-like material or ceramic for insulation. The other parts of the polypectomy snare are unchanged in comparison with conventional instruments. To date, the system has been used in 100 patients with gastrointestinal polyps. Symmetrical and asymmetrical snares with an insulated tip, rotatable in the axis of the guiding catheter, have been used with no complications occurring. The device is easy to use, reliable in clinical practice, and can be employed in conjunction with conventional high-frequency diathermy instruments. The polypectomy snare is inexpensive.

[Diffuse intestinal polyangiomatosis as a cause of recurrent intestinal hemorrhage. Report of an unusual case]. / Diffuse intestinale Polyangiomatose als Ursache rezidivierender intestinaler Blutungen. Bericht über einen ungewöhnlichen Fall.

We observed a 38-year-old Italian male with recurrent intestinal bleeding and consecutive iron-deficient anemia. For search of the source of bleeding intensive clinical, endoscopic and radiological investigations had been performed. Multiple malformations of superior mesenteric artery with abnormal vascularisation of jejunum and ileum were established angiographically. In addition the lumen of small bowel loops was dilated and enlarged mucosa folds were found. Because of a prominent vascularized area in the cecum a resection of the right hemicolon had been performed with consecutive death of the patient. The post mortem investigation revealed dilated mesenteric arteries, multiple cavernous hemangiomata in the mesenterium, in the wall of the small bowel and solitary in the large bowel. Additionally angiodysplasias, phlebectasias, lymphangiectasias, and lymphangiomata in the large bowel and in the mesenterium were found. "Diffuse intestinal polyangiomatosis" is the proposed term of the syndrome consisting of recurrent intestinal bleeding and multiple intestinal vascular malformations.

Pharmacokinetics of indoramin and its metabolite 6-hydroxyindoramin after single and multiple doses to cirrhotic liver patients.

Pharmacokinetic data obtained after intravenous and single and repeat chronic oral dosing of indoramin in nine patients with liver cirrhosis are described. Median plasma clearance is 11.2 ml/min/kg. Terminal disposition half-life is prolonged after intravenous as well as acute and chronic oral dosing (9.1 versus 10.7 versus 12.2 h). Median volume of distribution is 11.2 L/kg. Bioavailability is increased with a wide range of distribution from 12.2 to 75.4%. There is a slight tendency of accumulation during twice daily oral dosing that cannot be explained by the degree of prolongation of half-life. The kinetics of the main metabolite, 6-hydroxyindoramin, are substantially comparable to the kinetics of indoramin with a ratio of 6-hydroxyindoramin/indoramin calculated from the area under plasma concentration-time curve of 0.3, which is within the range of normal. All data suggest that the changed pharmacokinetics are due to altered liver perfusion as would be expected from a substance with a plasma clearance in the magnitude of liver perfusion in normal volunteers. It seems likely that, in patients with liver cirrhosis, similar alpha 1 blocking effects may be achieved with lower doses than in patients with normal liver function.

Hepatic artery embolization for treatment of endocrine gastrointestinal tumors with liver metastases.

We report about six patients with endocrine gastrointestinal tumors and liver metastases (four insulinomas, one carcinoidtumor, one paraganglioma), who were treated with a transluminal embolization of the hepatic artery when cytostatic therapy was ineffective. In two patients a second embolization was necessary after recurrence of clinical symptoms. All patients tolerated the procedure without severe side-effects and improved clinically. Serum insulin levels and HIAA-secretion rapidly decreased. Survival lasted from 3 to 32 months (median 15 months). Five additional patients with metastatic endocrine gastrointestinal tumors, observed during the same time period, were regarded as not suitable for hepatic artery embolization. In selected patients, hepatic artery embolization may become an effective therapy for treatment of metastasing endocrine gastrointestinal tumors when conventional medication with cytostatic drugs has become ineffective.

[Clinical significance of the 14C-glycocholate breath test in the diagnosis of gastro-enterological diseases (author's transl)]. / Klinische Bedeutung des 14C-Glykocholat-Atemtests in der gastroenterologischen Diagnostik bei Erkrankungen mit gesteigerter Dekonjugation von Gallensäuren

The 14C-glycocholate breath test was performed in 15 normal subjects and 134 patients clinically suspected of bacterial overgrowth in the proximal small intestine, with functional impairment of the ileum and chologenic diarrohea as well as other forms of diarrhoea. In addition, faecal weight, faecal fat excretion and faecal bile-acid excretion were measured. Early and highest 14CO2 expiration peaks were found as an expression of increased deconjugation of bile acids in patients with fistulae between proximal small intestine and colon, and in 13 of 24 patients with Billroth II gastric resection or duodenopancreatectomy. Bile-acid deconjugation was not increased in sprue, chronic pancreatitis with steatorrhoea, ulcerative colitis, irritable colon, Whipple's disease, Salmonella enteritis, non-specific enteritis, or laxative abuse. In six of twelve patients with Crohn's disease of the ileum there was an increase in deconjugation of bile acids.