[Eosinophilia, diarrhea]. / Eosinophilie, Durchfall.

A 46-year-old Swiss woman presents with intermittent abdominal pain and persistent eosinophilia that is suggestive of helminthic etiology. Though her stay in Africa goes back > 35 years, an imported disease is a possibility. However, contact with a puppy suggests a locally acquired organism. Antibodies to filariae and Toxocara are demonstrated in the serum. Following treatment with albendazole 400 mg daily for 14 days the patient makes a full recovery, and the final diagnosis is active Toxocara canis infection.

[Acute alveolitis due to mesalazine]. / Akute Alveolitis unter Mesalazin.

A 66-year-old male developed lymphocytic alveolitis with bronchiolitis after 3 month's treatment with mesalazin for ulcerative colitis. The patient's symptoms disappeared after halting mesalazin and increasing the steroid dose, the reduced diffusing capacity ameliorated and the thoracic X-ray normalized. The question whether this was a case of pulmonary involvement in inflammatory bowel disease or a drug side effect.

[Radiation proctocolitis following gynecologic radiotherapy: an endoscopic study]. / Strahlenproktokolitis nach gynäkologischer Radiotherapie: eine endoskopische Studie.

The prevalence of radiation injuries was assessed in 155 of 206 surviving patients who had had radiation therapy for carcinoma of the uterus or vagina. The patients were examined according to a standardized protocol. 51 (32.9%) exhibited endoscopic proctitis, and in 10 of them sigmoid colon was also affected. The prevalence of colitis was 31 of 66 (47%) in patients treated for carcinoma of cervix and 19 of 86 (47%) in those treated for carcinoma of corpus. 41 (80.4%) had clinical symptoms (bleeding and diarrhea in 53% each). The mean time lag between radiation therapy and beginning of symptoms was 9 months. Histology was positive in only 24 (47.1%) of 51 endoscopically documented cases of proctocolitis. There was no increase in the prevalence of radiation injury after previous surgery of any kind. Nor was higher risk found in patients with hypertension, diabetes, or congestive heart failure. However, patients with low body mass were at increased risk (p less than 0.01). There was a dose-response relationship between total dose and endoscopic proctitis (p less than 0.001). The incidence was 0% below 40 Gy, 20% at 60 Gy and 50% at 90 Gy.

[Esophageal obstruction in tube feeding: a result of protein precipitation caused by antacids?]. / Osophagusobstruktion während Sondenernährung: Folge von Eiweissfällung durch Antazida?

A complication of tube feeding, i.e. thickening of nutrient solution in the presence of an antacid leading to obstruction of the esophagus, is reported. Three patients on artificial breathing where fed by tube with Fresubin liquid. At intervals, Alucol liquid was given for stress ulcer prevention through the tube. After 2, 4, and 50 days respectively, reflux of nutrient solution into the mouth occurred. On removal of the tube a compact, yellowish-white substance was extracted. Endoscopically, residual particles were found in the upper part of the esophagus and in the hypopharynx which obstructed the esophagus completely and in one case could only be extracted through a rigid esophagoscope. In vitro studies showed that thickening of the nutrient solution was due to interaction with antacids administered simultaneously with the nutrient.

[Antacids--gel or tablet. A randomized, double-blind, placebo-controlled study]. / Antazida--Gel oder Tabletten. Eine placebokontrollierte, randomisierte Doppeltblindstudie.

A double blind placebo controlled trial was conducted to compare the effect of two antacid brands (liquid and tablet form) on fasting and postprandial intragastric pH. In 9 healthy volunteers intragastric pH was continuously recorded by solid state memory on 6 occasions. 40 mmol of each antacid was given one hour before and after a standardized meal. The time during which pH was below 3.5 during the first hour following each medication was, in the fasting state, 56.7 +/- 2.1 min. with placebo tablets, 30.7 +/- 8.0 min. (p 0.05) with magaldrate tablets, 26.6 +/- 8.0 min. (p less than 0.01) with Al-Mg-hydroxide tablets, 46.1 +/- 6.1 min. with placebo liquid, 18.4 +/- 5.2 min. (p less than 0.01) with magaldrate liquid, and 21.5 +/- 6.2 min. (p less than 0.01) with Al-Mg-hydroxide liquid. Postprandially the respective periods of time were 48.3 +/- 4.9 min. with placebo tablets, 45.4 +/- 4.6 min. (n.s.) with magaldrate tablets, 48.9 +/- 5.6 min. (n.s.) with Al-Mg-hydroxide tablets, 46.7 +/- 7.9 min. with placebo liquid, 26.6 +/- 9.3 min. (p less than 0.05) with magaldrate liquid, and 28.0 +/- 7.1 min. (p less than 0.05) with Al-Mg-hydroxide liquid. Both tested brands were equally effective. With regard to pH activity, both tested forms were more effective in fasting state than postprandially; tablets showed no measureable activity postprandially and were less effective than the liquid form. The usefulness of the usual medication of low-dosed antacids, one hour postprandially, is open to doubt.

[Sclerotherapy of esophageal varices. Indications and results]. / Sklerotherapie der Osophagusvarizen. Indikation und Resultate.

Injection sclerotherapy of esophageal varices is now firmly established. The indication and results are exemplified by the experience gained during the last 5 1/2 years at our institution. The early mortality rate within 30 days was 20% for patients needing emergency sclerotherapy during acute bleeding, and 4.4% for all other patients. The cumulative two-year survival rate of all patients was 54%. Further hemorrhage occurred in 4.8% per patient-month, mostly within the first year. Every acute esophageal hemorrhage should be treated with injection sclerotherapy. Repetition of this procedure reduces the risk of rebleeding. The indication for prophylactic sclerotherapy prior to first bleeding is not yet clearly defined. However, patients with increased risk of bleeding should have the benefit of injection sclerotherapy.

Adverse reactions following intravenous penicillin-G relate to degradation of the drug in vitro.

We have recently shown that high-dose intravenous therapy with penicillin-G always results in both sensitised lymphocytes and rise of anti-penicilloyl IgG antibodies. If penicillin-G is strictly given as freshly prepared bolus doses this sensitisation is prevented. In 193 patients, intravenous treatment with penicillin-G without special precautions (bolus doses stored up to 36 h at 4 degrees C or continuous infusions) led to 8.3% definite, 6.7% probable and 14.0% possible adverse reactions. In 116 patients treated exclusively with freshly dissolved doses, 0.9% definite, 1.7% probable and 4.3% possible reactions occurred. Whereas haemolytic anaemia (7) and neutropenia (12) were observed in 19 cases of the first group no such reactions were seen in the second group. Strict application of freshly prepared single doses prevents the majority of adverse reactions following highdose intravenous penicillin-G therapy. Degradation and transformation products formed in vitro are therefore the causative agents rather than the penicillin molecule itself.

[Amodiaquine-induced agranulocytosis in malaria prevention: demonstration of an amodiaquine-induced cytotoxic antibody against granulocytes]. / Amodiaquin-induzierte Agranulozytose bei Malariaprophylaxe: Nachweis eines amodiaquin-abhängigen zytotoxischen Antikörpers gegen Granulozyten.

A patient is presented who developed agranulocytosis while taking amodiaquine for suppressive therapy of malaria. An amodiaquine-dependent granulocytotoxic antibody could be demonstrated in the patient's serum on day 1 after stopping amodiaquine medication. Granulocyte transfusion was ineffective on days 6 and 7, possibly due to the slow elimination of the drug.

[Spontaneous radial segmentation of cell nuclei: morphologic marker of T-cell neoplasms?]. / Spontane Radialsegmentierung von Zellkernen: ein morphologischer Marker von T-Zell-Neoplasien?

Radial segmentation (RS) of leukocyte nuclei has been observed, for example, in leukemias (Rieder cells). In 6 of 8 patients with T-ALL, RS of neoplastic cells was found in the peripheral blood, whereas in 14 patients with non-T-ALL no RS cells were present. RS may be a morphologic marker for certain T-cell neoplasms, and with regard to ultrastructure it seems to be identical to heat-induced RS of non-neoplastic cells.

[The problem of infectiousness of tuberculosis patients during chemotherapy]. / Zur Frage der Infektiosität von Tuberkulosepatienten unter Chemotherapie.

In 1979 two patients with cavitary pulmonary tuberculosis were treated by a combination of three tuberculostatic drugs. During 12 1/2 and 16 1/2 weeks M. tuberculosis could be cultured in sputum and gastric juice respectively. Culturable M. tuberculosis are capable of infecting guinea-pigs and consequently are also infectious for humans.