[Lymphocytic gastritis--a rare disorder of the gastric mucosa]. / Die lymphozytäre Gastritis--eine seltene Erkrankung der Magenschleimhaut.

Lymphocytic gastritis, first described by Haot et al. in 1986, is a very rare form of gastritis (0.8-1.6% of cases) with unclear pathogenesis. On endoscopy, lymphocytic gastritis may present either a normal appearance, such as gastritis varioliformis with multiple elevated chronic erosions in the corpus and fundus, or as a giant fold gastritis in the corpus and fundus. This type of gastritis is diagnosed histologically based on an accumulation of intraepithelial lymphocytes (more than 25/100 epithelial cells) in the surface cells of the gastric mucosa. Its etiopathogenesis is currently thought to be a sprue-associated reaction or an atypical reaction to Helicobacter pylori infection. Some studies report the lymphocytic gastritis in almost 45% of cases of sprue, with the gastritis regressing in response to a gluten-free diet, while others report a correlation of lymphocytic gastritis with serologically and/or histologically confirmed H. pylori infection, with the lymphocytic gastritis being cured by H. pylori eradication treatment in a high percentage of the cases. It is possible that a similar abnormal immune reaction to an inflammatory agent underlies both pathological entities, sprue and lymphocytic gastritis--in the one case gluten and in the other H. pylori--which would mean that sprue-induced and H. pylori-induced forms of lymphocytic gastritis exist side by side.

Healing of lymphocytic gastritis by eradication of Helicobacter pylori.

BACKGROUND: It is not yet clear whether lymphocytic gastritis might not be a sequela of Helicobacter pylori (Hp) infection. The aim of the present pilot study was, therefore, to investigate whether lymphocytic gastritis can be cured by Hp eradication, which, if affirmed, would provide indirect evidence for an etiopathogenic relationship. PATIENTS AND METHODS: 98 of 220 patients with lymphocytic gastritis diagnosed between 1988 and 1998 were investigated at least twice, with 61 of them undergoing Hp eradication treatment. In 29 of these patients, the pretreatment histological work-up using the Warthin-Starry silver stain revealed Hp colonisation, while in the remaining 32 patients the biopsies from the antrum and corpus were negative for Hp. The other 37 patients received no treatment, and served as a control group. RESULTS: Both in the group with Hp-positive, and in the group with Hp-negative histology prior to treatment, eradication treatment led to healing of the gastritis, i.e. to regression of the gastritis parameters including normalisation of the intra-epithelial lymphocyte count, in 93.1% and 84.3% of the cases, respectively. In the control group the histological findings did not change. CONCLUSIONS: The results of our retrospective study support the notion that most cases of lymphocytic gastritis might be a consequence of Hp infection. This, however, needs to be clarified definitively by a prospective, randomized, double-blind study.

Pseudoexfoliation syndrome. Ocular manifestation of a systemic disorder?

The pseudoexfoliation syndrome has recently been suggested to represent the local manifestation of a more widespread disorder. In this study, a case of classic bilateral pseudoexfoliation syndrome with systemic distribution of pseudoexfoliation material involving a variety of organ systems is described. Using transmission electron microscopy, typical pseudoexfoliation fibers were identified in autopsy tissue specimens of skin, heart, lungs, liver, kidney, and cerebral meninges in addition to the classic intraocular locations. The pseudoexfoliation material was mainly localized to connective-tissue portions or septa traversing the various organs. The pseudoexfoliation fibers were consistently associated with connective-tissue components, particularly fibroblasts and collagen and elastic fibers; myocardial tissue specimens; and heart-muscle cells. These findings provide evidence for the systemic nature of the pseudoexfoliation syndrome, which apparently involves an aberrant connective-tissue metabolism throughout the body.

99mTc-labelled anti NCA-95 antibodies in prosthetic heart valve endocarditis.

A 54-y old women with earlier replacement of the mitral and aortic valves and clinical signs of localized endocarditis was studied with 99mTc-labelled anti NCA-95 antibody. Whereas echocardiographic findings were negative, increased radionuclide uptake was observed left parasternal over the mitral valve as a sign of prosthetic valve endocarditis. This result could be confirmed by a similar study with leukocytes labelled in vitro with 111In-oxine.

Influence of pancreatic duct occlusion on islet hormones in peripheral and portal plasma and in the pancreas of the mini-pig.

In a total of 18 'Göttingen' mini-pigs we studied basal glucose in the peripheral plasma, and the hormones insulin, glucagon, and somatostatin in the peripheral and portal plasma, as well as in extracts of pancreatic tissue, both in animals subjected to pancreatic duct occlusion with prolamine (Occ pigs) 9 months previously and in controls. Additionally, in the pancreas the relative frequency of A-, B-, D- and PP-cells was determined by immunocytochemistry. In peripheral blood of Occ pigs glucose, insulin, and somatostatin were unchanged, while glucagon was decreased. Also after occlusion the portal plasma revealed an increase in insulin but unchanged glucagon and somatostatin, while in the pancreatic tissue insulin and glucagon were statistically unchanged, but somatostatin was reduced. The relative frequency of A-, B-, D- and PP-cells in the pancreatic islets was comparable in both control and Occ pigs. It is concluded that also in the pig pancreatic duct occlusion leads to atrophy of the exocrine pancreas, but leaves undisturbed basal blood glucose, insulin, glucagon and islet cells.

New diagnostic and therapeutic possibilities in manifest idiopathic hemochromatosis.

Up until recently in clinical practice suspected hemochromatosis with a pathological iron-screening test (plasma iron, percentage transferrin saturation, serum ferritin, desferrioxamine-induced urinary iron excretion) made a liver biopsy necessary. Today, as a first step, the density of the liver parenchyma can be measured by means of computed tomography. Normal findings obviate the need for laparoscopy. Since the late forties weekly or twice weekly phlebotomy has been the sole form of treatment for manifest idiopathic hemochromatosis. In the mid-sixties the hopes placed in chelating substances (desferrioxamine) were not fulfilled, because the plasma half-life (only 7-10 minutes) of this drug was too short. Even with several daily injections only a small amount of iron was removed from the body tissue (10-25 mg daily urinary iron excretion). The introduction of portable infusion pumps in the late seventies offered us a new possibility of administering desferrioxamine by subcutaneous injection (Propper et al., 1976). Until that time such treatment was successfully used only in the field of pediatrics to treat secondary transfusion hemochromatosis in thalassemia. In one case of idiopathic hemochromatosis with severe organic involvement (right heart failure, repeated esophageal hemorrhage and bronzed diabetes) we had to achieve rapid iron elimination, and for this purpose we used continuous long-term desferrioxamine administration by means of a portable infusion pump (Autosyringe) in addition to phlebotomy. Since, particularly in the critical initial phase of treatment when heart failure was always threatening, great care had to be exercised in the use of phlebotomy, iron removal was achieved largely by desferrioxamine administration (daily up to 240 mg iron elimination in urine and stools).(ABSTRACT TRUNCATED AT 250 WORDS)

[Weight reduction on a commercially available minimal diet. Results of replacing 1 meal per day]. / Gewichtsreduktion durch eine industriell hergestellte Minimaldiät. Ergebnisse nach 14tägigem Ersatz einer Mahlzeit pro die.

Over a period of 14 days eight female outpatients ingested a new low-calorie formula diet (Enerday Protein) as a substitute for either dinner or lunch. This formula diet contains fructose as carbohydrate. In the two weeks of treatment an average reduction in weight of 2.7 kg (range: 2.0-3.4 kg) was observed, which means a daily weight loss of 193 g. Gastrointestinal disturbances or metabolic changes were not observed. This form of weight reduction was well accepted by the patients. Living and eating habits were not altered, since only one daily meal was replaced.

A special form of segmental pancreatitis: "groove pancreatitis".

"Groove pancreatitis" is a form of segmental pancreatitis affecting the head of the pancreas which is localized within the "groove" between the head of the organ, the duodenum and the common bile duct. We diagnosed this form of pancreatitis in 30 out of 123 surgical duodenopancreatectomy specimens of chronic pancreatitis (24.4%). In a comparison with non-segmental chronic pancreatitis, no differences was observed in age and sex distribution or in alcohol consumption. Clinically, in contrast, preceding diseases of the biliary system, peptic ulcers and gastric resections were more frequently indicated. The cardinal clinical finding is frequently duodenal stenosis; in sonographic and CT examinations, the cicatricial "plate" in the "groove" represents as a "tumor", so that--also on account of the frequent duodenal stenosis--a carcinoma of the head of the pancreas may be suspected. In groove pancreatitis, the pancreatic duct system is grossly normal, calcifications or intraductal protein plugs being rare and an adaptive intimal fibrosis of the intrapancreatic arteries and arterioles is found only within the cicatricial area. Very commonly, scarring of the duodenal wall, stenosis of the duodenum, true duodenal wall and pancreatic cysts are detected. Aetiopathogenetic possibilities are previous diseases of the biliary system, peptic ulcers, gastric resections, true duodenal wall cysts, pancreatic head cysts, pancreatitis in duodenal pancreatic heterotopia, and disturbances of pancreatic juice outflow in Santorini's duct in the absence of the minor papilla, and hyperstimulation in consequence of chronic alcoholism.

Epithelial dysplasias in chronic pancreatitis.

The present 280 specimens of chronic pancreatitis were examined to determine the type and frequency of epithelial dysplasia of the duct system. The epitheilal dysplasias were divided into 3 degrees of severity according to cytological and histological criteria. Dysplasia was demonstrable in 40.1% of the 280 specimens. Of these 32.9% were classified as dysplasia grade I and 7.1% as dysplasia grade II. Dysplasia grade III did not occur. The epithelial proliferations were correlated with the topography, the stage of the scarring and the degree of obstruction of pancreatic secretion. An increase in dysplasia was evident in relation to the stage of the scarring and to the obstruction of secretory outflow. In correlation with the topography of the chronic pancreatitis there was the highest frequency of epithelial dysplasias in uniformly scarred glands (47.7%). Papillary and pseudopapillary hyperplasias with atypia were demonstrated in 17.9 vs. 4.5% of the cases with epithelial proliferations.

[Dosage-problems in controlled sodium nitroprusside hypotension in oto-rhino-laryngological surgery (author's transl)]. / Dosisprobleme mit Natriumnitroprussid bei kontrollierter Hypotension in der Hals-, Nasen- und Ohrenchirurgie.

During a study of 130 patients undergoing hypotensive anaesthesia for oto-rhino-laryngological surgery the most important dose problems with sodium nitroprusside (S.N.P.) were characterized. In 14% of the cases more than 15 mcg/kg body weight/min S.N.P. were required. Our data show, that the smallest S.N.P. consumption occurs during neuroleptanalgesia in combination with 0.3--0.8 Vol-% enflurane. On the other hand, during neuroleptanalgesia alone, in several cases toxic amounts of S.N.P. would have been necessary to produce adequate hypotension. In such cases about 0.5 mg/kg body weight dihydralazine must be employed as a supporting agent for hypotension. The influence of this drug on the manoeuvrability of the low pressure state and on the administration of S.N.P. was investigated. Although, the equivalent amount of sodium thiosulfate (S.T.) did not increase the S.N.P. sensibility, its routine use is reconviended, since the combination of S.Th, and even higher doses of S.N.P. were tolerated without metabolic acidosis. As an alternative substance after long-term use of S.N.P. nitroglycerine should be used.