[Palliative therapy of stenosing reflux esophagitis].
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Biomedical subjects
Publications and source records attributed to B Hammer.
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The rate of side effects, the results of EMG, EEG and CSF changes after radiculography, the rates of late leptomeningeal changes and the details of the hyperosmolality following the ionic contrast media are recorded and discussed. In conclusion rules are presented for the choice of contrast medium and the examination technic for radiculography.
A prospective study was undertaken to determine the frequency of transient bacteremia on recto-sigmoidoscopy. Blood specimens were drawn for aerobic and anaerobic bacterial culture immediately before, and 1, 5, 10, 15, 20, 25 and 30 min after the beginning of recto-sigmoidoscopy. 19 blood cultures were supposed to be contaminated. In 3 patients (6%) a positive blood culture was found with the following types of organisms: enterococci, Escherichia coli and nonhemolytic streptococci. The need for antibiotic prophylaxis in patients with valvular heart diseases or prosthetic valves is discussed. In such cases the authors propose prophylaxis with 1 g streptomycin i.m. and 3 g ampicillin by mouth 30 min before recto-sigmoidoscopy.
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Monocytopoietic proliferation activity was determined in 8 patients during severe attacks of Crohn's disease and in 6 patients with ulcerative colitis. Similar results were obtained in both groups of patients. A moderate but significant hyperproliferation of monocytopoiesis was found to be present in about half of the patients, and with some of the remainder of cases, part of the criteria for hyperproliferation were also fulfilled. This indicates that Crohn's disease as well as ulcerative colitis are frequently associated with moderate overproduction of monocytes which may be assumed to be induced by macrophage demand of the affected tissues. In comparison with other diseases involving inflammations, the monocytopoietic hyperproliferation was moderate. Therefore, the inflammation in Crohn's disease and ulcerative colitis seems to be characterized by a relatively low macrophage turnover induced by pathogenetic mechanisms of moderate macrophage toxicity.
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A further Swiss family with hereditary chronic relapsing pancreatitis is reported. Five members definitely have the disease, while in 4 subjects the condition is suspected. The five proven cases are a mother and her four children. All suffer from recurrent attacks of abdominal pain which started between the 8th and 20th year of life, and in all of them exocrine pancreatic insufficiency and pancreatic calcifications can be demonstrated. The mother has had diabetes mellitus since the age of 40 and 3 of the 4 children also have the disease, with age of onset between 15 and 29. In 3 patients insignificant traces of aminoacids could be detected in the urine. At 16 years one male patient had a pseudocyst of the pancreas surgically removed. All the others are treated conservatively. Reports on approximately 25 families with this disease have been published so far. The condition is inherited as an autosomal dominant disorder. Typically, the clinical symptoms begin during childhood or early adolescent life. The pathogenesis is unknown. It is possible that an abnormal pancreatic juice is produced which causes the intracanalicular calcifications. The treatment is identical to that in the non-hereditary forms, i.e. generally conservative. Recently some authors have favored a more aggressive approach consisting of pancreatico-jejunostomy or partial resection of the pancreas.
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In Schweizerische Medizinische Wochenschrift 106, 894-897 (1976) an article was published on a kinship with hereditary "minor adenomatous polyposis" of the colon with a higher than expected incidence of carcinoma of the stomach. Evidence for a genetic relationship between this family (Sch.) and another branch with an isolated case (Sch. E.) of familial polyposis of the gastrointestinal tract was found. The patient Sch. E. is presented here. The polyposis of this patient is phenotypically identical with that found in the classical familial polyposis of the colon, but also exhibits features of "minor adenomatous polyposis". A systematic clinical-endoscopic examination of ten members of the patient's family produced no further cases of gastrointestinal polyposis of carcinomata. In the case of Sch. E., therefore, a spontaneous mutation is postulated. A new classification of the various types of colonic polyposis is suggested.
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In order to increase the accuracy of preoperative "type-diagnosis" fifty meningiomas in various sites were investigated by brain-scan, and routine angiography. Some cases in addition had external carotid angiography and angioscintigraphy of the external and internal carotid. By tabulating the findings, it is possible in 90% of cases to provide a pre-operative "type-diagnosis" of meningioma. Details are given regarding the influence of the tumour site on the ability to demonstrate the tumour through branches of the external or internal carotid, as well as "filling defects" or isotope uptake in angioscintigraphy. The reasons are discussed for the lack of agreement about the size of the tumour, in angiogram and angioscintigram, as well as in the brain-scan, in 15 out of 34 meningiomas.
Late meningeal changes due to various contrast media of the water-soluble type used for radiculography were analysed and the causes for the changes are discussed. The osmotic properties of the substance are an important aspect of the contrast medium. Hints for avoiding late complications are given.
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