[Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings]. / Idiopathische, eosinophile Osophagitis: eine häufig verkannte Krankheit mit typischer Klinik und diskretem endoskopischem Bild.

In 10 patients presenting with acute recurrent dysphagia, seen over a 4-year period, idiopathic, eosinophilic esophagitis (IEE) was diagnosed. The diagnosis was confirmed histologically. Dysphagia of other causes or other diseases causing eosinophilic infiltration was ruled out. Endoscopy showed discrete white structures in the esophagus which were partly finely reticular or plaque-like in 9 of the 10 patients. Of these one had a web and another a mucosal ring. Peripheral eosinophilia and elevated IgE-levels were found in 70% of the cases. To date IEE has been thought to be a rare disorder. Emerging evidence suggests its prevalence has been underestimated. It may also be the most frequent form of eosinophilic gastroenteropathy. The flat, only endoscopically visible form may be more common than the proliferative type. With knowledge of the typical history and of the distinct endoscopic pattern, and with adequate diagnostic workup, the disease will be found more often in the future. Prompt diagnosis also avoids further diagnostic procedures and permits rapid remission through treatment with steroids and antihistamines.

[Familial incidence of colorectal carcinoma and its significance for a screening program (the example of Upper Basel area)]. / Familiäre Häufung des kolorektalen Karzinoms und deren Bedeutung für ein Screeningprogramm (Beispiel oberes Baselbiet).

Primary prevention of colorectal carcinoma aims at interruption of the adenoma-carcinoma sequence. Colonoscopy is the most reliable screening method, but up to now has only been recommended for persons at high risk. The ongoing 10-year study defines a possible risk group and determines the efficacy of a preventive screening program based on family history. This paper reports on the descriptive statistics of the first five years. All patients with colonic carcinoma diagnosed between 1987 and 1991 living in the upper part of Canton Basel-Land were registered. According to the family history, patients with at least one first degree relative with colonic carcinoma were defined as index patients. Their first degree relatives entered a prospective screening program which includes colonoscopy. 230 colonic carcinomas were diagnosed in the upper part of Basel-Land, representing an incidence of 48/year/100,000 persons. They included 3 (1.3%) hereditary and 227 (98.7%) sporadic carcinomas. 23 (10%) patients had a positive family history. These patients defined 94 relatives at risk. The incidence of colonic carcinoma in the Canton studied does not differ from that reported in Switzerland. Therefore, this part of Basel-Land can be considered representative. The 1.3% hereditary carcinomas are in contrast to the published data of 6%.

Diagnosis of bacterial overgrowth after culturing proximal small-bowel aspirate obtained during routine upper gastrointestinal endoscopy.

The purpose of this study was to evaluate the method of obtaining aspirated fluid for culture from the small intestine through a fiberoptic gastrointestinal endoscope for diagnosing small-bowel overgrowth. The study population consisted of 10 healthy volunteers and 26 patients with various gastrointestinal problems referred for routine endoscopic examination. The material to be cultured was obtained under direct visualization approximately 25 to 30 cm distal to the pylorus or from the afferent loop (in Billroth-II patients) with a sterilized sheathed wash pipe passed through the suction channel of the endoscope. Cultures were considered positive for bacterial overgrowth if total counts of organisms were 10(5)/ml or more. All healthy volunteers and 16 of 21 unoperated patients had sterile or insignificant growth, whereas all 5 patients who had Billroth-II operations had positive overgrowth. The endoscopic method for collection of proximal gastrointestinal fluid for culture is simple and can be performed during routine endoscopy.

[Campylobacter pylori, gastritis and ulcer disease. Microbiological, histological and serological studies]. / Campylobacter pylori, Gastritis und Ulkuskrankheit. Mikrobiologische, histologische und serologische Untersuchungen.

In a prospective study of 70 patients with epigastric pain, gastroduodenoscopy revealed gastric and/or duodenal ulcers in a total of 41 and no ulceration in the remainder. Biopsies were taken to assess the severity of gastritis and the presence of Campylobacter pylori (CP) by histology and culture. Gastritis was found in 54 patients. CP was detected in 78% of the ulcer patients and 52% of the patients without ulcer (p less than 0.05). CP was demonstrated in 83% of the histologically diagnosed cases of gastritis (all grades) but no CP was detectable in patients with normal gastric mucosa. Among the ulcer patients, CP was more frequent in those with no history of medication with nonsteroidal antiinflammatory drugs (p less than 0.01). Sera from CP-positive ulcer and gastritis patients have significantly higher levels of IgG antibodies to CP than sera from those found to be free of ulcer or gastritis. In 200 blood donors an increasing percentage of elevated CP-antibody titres were found with advancing age (50% over 60 years of age). Quantification of circulating CP antibodies, would thus seem a valuable adjunct in the diagnosis of gastritis and probably also of peptic ulcer. The data presented furnish further evidence of the high rate of association of CP and the gastritis-peptic ulcer complex.

[Pyogenic liver abscess]. / Der pyogene Leberabszess.

27 patients who presented with pyogenic liver abscess from 1957 to 1984 are analyzed retrospectively and compared with the literature. Diagnosis and start of therapy were frequently delayed because of the unspecificity of symptoms. Symptoms included fever, abdominal pain, weakness, and loss of weight. In 50% of all patients, the abscess was found by chance at laparotomy or autopsy. The most frequent causes of abscess formation were cholestasis due to extrahepatic obstruction and intraabdominal infections. Frequently a predisposing condition such as carcinoma, diabetes mellitus or alcohol abuse was found. The overall mortality was 25%, and was higher in patients with multiple abscesses of the liver (36%) than in patients with solitary abscesses (10%). With the introduction of new imaging procedures (ultrasound, computer tomography), the abscesses can be punctured under view and the antibiotic therapy can be based on bacterial analysis. The causative bacterial organism could be identified by cultures of the abscess fluid and blood in up to 90%. The bacteria identified usually were identical to the intestinal flora. Using specific antibiotic therapy, surgical treatment is often unnecessary and can be reserved for abscesses resistant to conservative treatment and for those due to correction of the original source of abscess formation.

Diffuse peritonitis and chronic ascites due to infection with Chlamydia trachomatis in patients without liver disease: new presentation of the Fitz-Hugh-Curtis syndrome.

Two women were admitted for increasing abdominal pain, vaginal discharge, and severe or moderate chronic ascites. Diffuse peritonitis without evidence of liver disease was found in both cases, and in one the ascites and vaginal discharge contained Chlamydia trachomatis. Both patients responded to doxycycline, and this and the laboratory findings pointed strongly to C trachomatis as the aetiological agent. C trachomatis may cause severe peritoneal infections with chronic ascites formation in the absence of liver disease in women with the Fitz-Hugh-Curtis syndrome. Prompt diagnosis and antibiotics lead to rapid cure.

[Dengue fever as an imported disease in Switzerland]. / Dengue-Fieber als Importkrankheit in der Schweiz.

A report is presented on 2 tourists returning from the Indian Ocean area in whom clinically overt dengue fever was diagnosed. The epidemiology, pathogenesis and clinical course of the disease are discussed.

Antipyretic activity of fluproquazone in man.

A multicentric, double-blind, randomized, parallel-group study was performed in patients with fever of diverse origin to test the tolerance and the antipyretic activity of single oral doses of 4-(p-fluorophenyl)-1-isopropyl-7-methyl-2(1H)-quinazolinone (fluproquazone) (200 mg, n = 18), acetylsalicylic acid (ASA) (1000 mg, n = 22) and placebo (n = 19). Whereas with placebo mean rectal temperature remained constant, a continuous fall was recorded with both active medications over the whole 3-h study period. With fluproquazone normalization of body temperature was nearly reached. Fluproquazone was more effective than placebo (p less than 0.001) and ASA (p less than 0.1), which in turn was more active than placebo (p less than 0.0001). No specific side-effects occurred.

[The effectiveness of various micropore blood filters (author's transl)]. / Die Wirkung verschiedener Micropore-Blutfilter

Recently so-called micropore blood transfusion filters have been introduced. They should decrease the number of microemboli produced by blood transfusion and thus decrease the incidence of postoperative and posttraumatic pulmonary insufficiency. Since these filters are rather expensive and several types and models are offered, it seemed to us important to review their properties and the results obtained with the most commonly used models (Pall, fenwal, Swank and Bentley). The efficacy of the various filters is apparently quite different. Depending on the indication, the use of different filters is possible. There is no filter which fulfils all prerequisites which must be made for an ideal micropore filter. On the basis of our literature review we conclude that filters made of Dacron wool are best suited for all purposes. There are no good reasons to use these micropore filters routinely for all blood transfusions. However, when large amounts of blood must be given rapidly and pulmonary function is already reduced, the use of micropore filters routinely for all blood transfusions. However, when large amounts of blood must be given rapidly and pulmonary function is already reduced, the use of micropore filters seems reasonable.

[Is there an indication for the use of "micropore-blood filters"? (AUTHOR'S TRANSL)]. / Ist die Verwendung von "Mivropore-Blutfiltern" indiziert

Recently "micropore" blood transfusion sets have been advocated to replace the traditional transfusion sets. Because of the higher cost it is important to review critically the data which would justify their clinical use. The filters eliminate microaggregates as they occur during blood storage. The question is wether micropore filters are able to reduce the incidence of posttraumatic or postoperative respiratory insufficiency. We have analysed all controlled in vivo studies. We found only one clinical study where in massively transfused polytrauma patients a decrease in the number of cases of respiratory insufficiency was documented. However, due to the small number of patients investigated, a significant difference in favour of the micropore filters could not be demonstrated. Animal experiments reveal more: Exchange transfusions carried out in dogs through micropore filters do not lead to functional or morphological pulmonary changes. Using traditional transfusion sets, a significant increase in pulmonary artery pressure and resistance was found together with a decrease in arterial pO2, pH and oxygen consumption. All these results correlate well with morphological changes in the lung. On the basis of our literature review, we conclude that there are no clear data which would make it mandatory to use micropore filters in clinical practice. On the other hand, there are several indirect hints than large amounts of microaggregates are not ideal for pulmonary function. The expensive micropore filters could therefore perhaps be used with advantage in massive tranfusions.