[Quality of diagnostic procedures and frequency of endoscopically defined diseases of the upper gastrointestinal tract]. / Zur Qualität der Diagnostik und zur Häufigkeit endoskopisch definierter Erkrankungen des oberen Gastrointestinaltraktes.

The aim of this clinical investigation was to register the frequency of endoscopically defined diseases of the upper intestinal tract in a given region (Münster and Münsterland) within the period of one year (1.8.1999-31.7.2000). Furthermore, we tried to get an impression on the quality of the upper intestinoscopies by standardised conditions which had been developed by a steering committee (endoscopists and pathologists). 20 physicians (internal specialists and gastroenterologists) examined non-preselected patients and registered all relevant findings in the upper intestinal tract. The following items were of special interest: sex, age, operations in the past, indication, way of preparation, local findings (in the upper intestinal tract), and histological assessment. The examination forms were gathered, checked for completeness and evaluated statistically. Within the given period 8859 examinations forms (45.2% male and 54% female) could be evaluated. In 16% of the patients a reflux oesophagitis was diagnosed, three times more frequently than could have been expected anamnestically regarding the patients' complaints. In 274 patients (3%) the endoscopist suspected a Barrett's oesophagus; the according histological examination confirmed this suspicion in only 125 cases. Furthermore 17 adenocarcinomas and 13 squamous cell carcinomas were found. Macroscopically 44 polyps were registered but not all of them were biopsied. In 257 patients oesophageal varices (of varying degrees) were described. Only in 30.7% of the patients a H. pylori infection (diagnosed by urease test and by histological examination) was detected in the mucosa of the stomach. In 172 patients a gastritis was macroscopically suspected but the following histological assessments were not sufficient. The prevalence of gastric ulcers was 10 %, higher than the prevalence of duodenal ulcers. Only in 50% of the patients with a duodenal ulcer a H. pylori infection could be detected. In 51 cases carcinomas (diagnosis histologically confirmed) were found with the same ratio of the diffuse type and the intestinal type. In 18 patients a carcinoma could be detected in the neighbouring area of gastric ulcers. The endoscopic findings in this investigation do not differ significantly from the results found in literature. It is important that there are more gastric ulcers than duodenal ulcers. This can be explained by the frequent use of PPIs which are prescribed additionally to NSARs and ASS. The deficits of histological diagnostics on Barett's oesophagus and gastritis were remarkable. An improvement of the endoscopic and histologic assessment quality by valid standards systematically applied should be aimed at in future. Furthermore it could be helpful to use the same nomenclature for pathologic findings to intensify the co-operation between the physicians in hospitals and the practitioners.

[Ultrasound diagnosis of pseudomembranous colitis]. / Sonographische Diagnostik der pseudomembranösen Colitis.

BACKGROUND AND OBJECTIVE: The diagnosis of pseudomembranous colitis (PMC) is based on the history of exposure to antibiotics, characteristic endoscopic findings and on demonstrating the presence of Clostridium difficile toxins in the faeces. This report presents typical sonographic features of PMC. PATIENTS AND METHODS: The sonograms of 13 patients with PMC (7 males, 6 females, median age 70 years, range 55-84 years), were retrospectively analyzed. Patients' histories, clinical findings, the results of colonoscopy including histological findings and microbiological tests were related to the sonographic features of inflammation of the colon. RESULTS: At sonography the wall of the colon was thickened (6-17 mm) in each of the patients, different types of changed wall-architecture were seen. In 85% sonographic signs of colitis were restricted to the left colon, whereas in 15% a pancolitis was diagnosed. Ascites was detected in 38%, the colon contents were visible in 85%, in 77% the lumen was narrowed. Colonoscopy confirmed the diagnosis in six patients, in two patients endoscopy was performed only to control the effect of therapy and in five patients endoscopy was thought to be unnecessary. CONCLUSION: Sonography can supplement history and clinical findings if PMC is suspected. Potentially life-saving therapy can be initiated even if colonoscopy has not been performed and results of microbiological assessment are not yet available. However, the diagnosis of PMC remains to be based on the gold standard of colonoscopy and histological findings.

[Coccidioidomycosis as the cause of granulomatous hepatitis]. / Kokzidioidomykose als Ursache einer granulomatösen Hepatitis.

UNLABELLED: The case of 36-year-old man is reported who fell ill with a febrile infection, shortly after returning from several weeks to Mexico. EXAMINATION: Chest X-ray revealed a pulmonary infiltration. Also, the levels of liver function tests (gamma-GT, alkaline phosphatase, SGOT, SGPT) were clearly increased. As there were no signs of extended bile ducts in ultrasonics, a liver biopsy was indicated. The histology showed a granulomatous hepatitis. DIAGNOSIS: The exposure during the Mexico-trip, the pulmonary infiltration, the histology and the significant raised titers in specific serological tests led to the diagnosis of a general infection by the fungus coccidioides immitis. In addition to pathogenetic aspects of coccidioidomycosis the diagnostic approaches and relevant therapeutic strategies are discussed.

[Iatrogenic Candida infection in pancreatic pseudocyst]. / Iatrogene Candidainfektion von Pankreaspseudozysten.

We report the case of a 34-year-old woman, suffering from severe alcoholic hepatitis and an acute recurrence of chronic pancreatitis, who developed a life-threatening candida infection of pancreatic pseudocysts 12 days after ERCP. After percutaneous catheter drainage under ultrasound guidance this infection was healed by a combined intravenous and intracavity therapy with amphotericin B and the final instillation of tetracycline in order to reinforce obliteration of the pseudocysts.

[Invasive amebiasis with detection of Entamoeba histolytica in rectal biopsies and liver abscesses]. / Invasive Amöbiasis mit Nachweis von Entamoeba histolytica in Rektumbiopsien und Leberabszessen.

A 45-years old man after having returned from Thailand was admitted to the hospital with a severe ulcerative, pyogenic colitis and multiple liver abscesses. In the endoscopically taken rectal biopsies as well as in the liver abscess aspirate gained by fine needle puncture Throphozoites of E. histolytica could be demonstrated. On the other hand stool specimens and serology were negative. The various diagnostic facilities in invasive Amebiasis are discussed. Because of the problems, which may arise from the examination of fresh stool specimens, the advantage of endoscopically gained biopsies in suspected amebic colitis is emphasized.

[The functional sensitivity of the parietal cells in various gastric diseases (author's transl)]. / Die funktionelle Empfindlichkeit der Belegzellen bei verschiedenen Magenerkrankungen.

The phenomenon of the spontaneous parietal cell sensitivity not induced by drugs is described in a number of gastric diseases. Different parietal cell sensitivity can be assumed. 1. when there is a shift in the dose response curve between the aid output and continuous intravenous application of a stimulant, 2. when there is a deviation from the linear correlation between the parietal cell mass or rather the parietal cell density, and the maximal acid output, 3. when there is a changed time course of the acid secretion in response to continuous intravenous infusion of a fixed dose of stimulant. A parietal cell hypersensitivity exists in some patients with an uncomplicated duodenal ulcer. A hyposensitivity can be detected in patients with selective vagotomy, isolated chronic atrophic gastritis of the antrum, antrectomy, and chronic atrophic gastritis of fundic mucosa. It is not yet possible to estimate the importance of the different parietal cell sensitivity for the pathophysiology of human gastric diseases.

[Halothane and antituberculous drugs--a hepatotoxic combination? (author's transl)]. / Halothan und Tuberkulostatika als hepatotoxische Arzneimittelkombination.

A case report is given on two patients receiving halothane anesthesia while beeing treated with isoniacid, ethambutol and rifampicin. Following halothane anesthesia, both patients developed a severe liver disease with encephalopathy grade III. We observed a moderate increase of bilirubin and SGOT and a more severe increase of serum ammonia. Histologically, both patients had alterations compatible with drug hepatitis. Within 14 days remission occurred spontaneously. The two case reports do not fit with typical isoniacid hepatitis or typical halothane hepatitis. The possibility of combined drug toxicity on liver during halothane and isocianid treatment is discussed.

Effect of fatty acids on the stimulated gastric secretion in man.

Solutions and emulsions of sodium or potassium salts in a series of saturated fatty acids from C8 to C18 were given in a dose of 0.5 g intraduodenally to healthy males or patients with healed duodenal ulcer. A double-lumen Sarles tube with a balloon placed in the proximal duodenum was used. The substances were instilled after a plateau of gastric acid secretion induced by a continuous infusion of pentagastrin was reached. In order to exclude unspecific effects, the test solutions were adjusted to a pH around 7.0 and to plasma isosmolality. Compared with the other tested substances, the emulsion of 0.5 g sodium-oleate was the most effective in inhibiting the stimulated gastric acid secretion. Sodium caprinate and caprylate had a considerable, but smaller effect than oleic acid on the secretory plateau. Palmitate and laurate provoked only a slight decrease in acid secretion. Myristate was ineffective. These results could suggest that different receptors are responsible for fat-induced inhibition of the gastric acid secretion.