Biomedical subjects

C Meyenberger

Publications and source records attributed to C Meyenberger.

At least 73 records · Page 4Linked to original sources

PubMed1994

Chlorpromazine-induced vanishing bile duct syndrome leading to biliary cirrhosis.

We describe a 33-yr-old pregnant woman in whom a primary biliary cirrhosis-like syndrome developed after 2 wk of chlorpromazine therapy. The clinical course was characterized by severe jaundice lasting 22 mo, intense pruritus, fever, steatorrhea, high alkaline phosphatase levels and hypercholesterolemia. Jaundice resolved with initiation of ursodeoxycholic acid therapy, but subclinical cholestasis and low-level inflammatory activity persisted and ultimately evolved into biliary cirrhosis. The pathological substrate of this severe and prolonged cholestatic reaction was found to be the vanishing bile duct syndrome with a marked transient pseudoxanthomatosis.

Adult↗

PubMed1994

[High-resolution magnetic resonance tomography of the lesser pelvis using an endorectal coil].

Spatial resolution of MRI within the true pelvis can be increased by a factor of 12 using an endorectal coil. The value of this new method for demonstrating the prostate, the rectum, the cervix and vagina and of pathological processes of these organs was examined in 89 patients and the results compared with conventional body coil MRI. In 25 patients who underwent radical surgery the results of the preoperative studies were compared with the histological findings. Detailed recognition of anatomical structures was markedly improved by using the endorectal coil. Diagnosis of carcinoma of the prostate and extension of the tumour was accurately assessed in 33 patients. Preoperative staging was correct in 87%, compared with 73% when using a body coil. The difference was less marked in examinations for carcinomas of the rectum, the cervix and vagina. Nevertheless, staging was more accurate in a few cases with a better recognition of recurrences. MRI with endorectal coils will have an important role in diagnosis of carcinomas of the prostate in the future. Its use in the diagnosis of carcinomas of the rectum and cervix must be subject to further studies.

Adolescent↗

PubMed1994

Pancreatic tumors: evaluation with endoscopic US, CT, and MR imaging.

PURPOSE: To compare the value of endosonography (endoscopic ultrasound [US]), dynamic computed tomography (CT), and magnetic resonance (MR) imaging in the evaluation of pancreatic tumors. MATERIALS AND METHODS: Forty-nine consecutive patients with clinical suspicion of pancreatic tumor underwent endoscopic US (n = 49), CT (n = 46), and MR imaging (n = 25). The final diagnosis of a malignant (n = 22), benign (n = 2), or inflammatory (n = 9) tumor, or no (n = 16) tumor was made at surgery (n = 28) and/or a combination of biopsy (n = 9) and 9-24-month follow-up (n = 12). RESULTS: The sensitivity was 94% for endoscopic US, 69% for CT, and 83% for MR imaging. Specificity was 100% for endoscopic US, 64% for CT, and 100% for MR imaging. Accuracy was 96% for endoscopic US, 67% for CT, and 84% for MR imaging. The sensitivity for the detection of tumors less than 3 cm in diameter was 93% for endoscopic US (n = 15), 53% for CT (n = 15), and 67% for MR imaging (n = 12). CONCLUSION: Endoscopic US is more accurate than dynamic CT and MR imaging in the diagnosis of pancreatic tumor, particularly for tumors less than 3 cm in diameter.

Carcinoma, Ductal, Breast↗

PubMed1994

Alcoholic nonprogressive chronic pancreatitis: prospective long-term study of a large cohort with alcoholic acute pancreatitis (1976-1992).

140 patients with alcoholic acute (recurrent) pancreatitis were enrolled in a prospective long-term study over the last 16 years. Regular control studies regarding progression to advanced chronic pancreatitis were performed. Based on long-term outcome the patients were classified into two groups: group A (n = 109; 77.8%) with progression to advanced chronic pancreatitis (84% with calcification, 95% with exocrine insufficiency) and group B (n = 31; 22.2%) without progression (no calcification, no exocrine insufficiency). The two groups were comparable in age, sex, and mean duration of disease from onset (13.1 +/- 5.2 vs. 13.8 +/- 4.9 years). Surgery for pseudocysts was performed in 47% of group A and in 29% of group B. In group B, no pancreatic duct dilatation occurred (in 86% > 8 years from onset). However, 4 of 7 patients with adequate histology showed unequivocal chronic pancreatitis. Surprisingly, all patients of group B except two got spontaneous lasting pain relief irrespective of alcohol intake or normal pancreatic function. Our findings indicate that a subgroup of alcoholic acute pancreatitis does not progress to advanced chronic pancreatitis. This subgroup may be identical with "small duct" chronic pancreatitis. The factors responsible for progression (group A) or nonprogression (group B) remain to be elucidated.

Adult↗

PubMed1993

[Abdominal pain, fresh blood in the anus].

A 60-year-old lady with type II diabetes, arterial hypertension and 'melancholia' was treated with Lithium, a neuroleptic (Leponex) and an ACE inhibitor (Reniten). She was referred to our hospital because of abdominal pain, subfebrile temperatures, diarrhea and hematochezia. The radiological and sonographic examinations showed a thickened wall of the left hemicolon. Colonoscopy revealed a sharply delineated segment with pronounced inflammation in the descending colon and the proximal sigmoid colon, suggestive for an ischemic colitis. Histology of the inflamed colon was compatible with this diagnosis. Under suspended enteral feeding and antibiotic therapy the symptoms disappeared within two weeks, and a control colonoscopy six weeks later was completely normal. 1 1/2 years later the patient suffered from a second episode of ischemic colitis exactly a the same site. Again, complete cure was achieved by conservative treatment.

Anti-Bacterial Agents↗

PubMed1993

[Transient eosinophilia in primary biliary cirrhosis].

We reviewed 144 differential white blood cell counts from 23 patients with primary biliary cirrhosis (PBC, 21 females, 2 males) for occurrence of eosinophilia. Over an average observation time of 43 +/- 9 months, 9/23 (39%, 9 female) patients were found to have transient absolute (> 500/mm3, n = 5) or relative (> or = 6%, n = 4) blood eosinophilia. The maximum value of eosinophilic granulocytes observed was 1385/mm3 (19%). Other causes of eosinophilia had been ruled out. Eosinophilia was transient, disappearing without treatment. Significantly younger patients with eosinophilia also had a tendency to prognostically more favourable values for serum albumin, prothrombin time, bilirubin and galactose elimination capacity. None had edema, compared to two patients with edema in the group without eosinophilia. Two patients died during the observation period; both were from the group without eosinophilia. The average 5- and 7-year survival probability, calculated on the Mayo survival model, tended to be higher for patients with eosinophilia (92% and 87%) compared to patients without eosinophilia (79% and 72%). In patients with eosinophilia, disease stage I (5/6 vs 1/9) and epitheloid cell granuloma (4/6 vs 1/9) were significantly more frequent. Blood eosinophilia in PBC seems to be an indicator of an early disease state with florid bile duct lesions. Primary biliary cirrhosis should therefore be considered--with other hepatopathies--as a possible cause of eosinophilia of otherwise unknown origin. These observations could be of importance for future therapeutic concepts, at least for patients in early disease states.

Adult↗

PubMed1993

[Hepatosplenic schistosomiasis: case report and clinical review].

Although seen rarely in Switzerland, schistosomiasis is a parasitosis affecting 200 to 250 million people round the world, mainly in tropical and subtropical regions of Africa, Asia, Central and South America. Depending on the parasitic species, the ureters and the bladder (S. haematobium) or the intestine and the liver (S. mansoni, S. japonicum, S. mekongi) are primarily involved. Other organs may be affected (lung, kidneys and central nervous system). Hepatosplenic schistosomiasis represents a special form of chronic infection by S. mansoni, S. japonicum or S. mekongi predominantly occurring in adolescents heavily and repeatedly infected during childhood, together with an additional genetic predisposition for the disease. Hepatosplenic schistosomiasis on a worldwide scale is one of the most prevalent causes of portal hypertension in man. We describe a 33-year-old Portuguese female with mansonian hepatosplenic schistosomiasis 12 years after leaving Africa, who had hepatosplenomegaly, portal hypertension, esophageal varices and hypersplenism. Splenomegaly and slight anemia had been known for years without prompting further work-up. Two months before diagnosis she had been delivered of a normal child after pregnancy without portal-hypertensive complications, namely esophageal hemorrhage. Because of placenta accreta, however, erythrocyte transfusion had been performed after delivery and was possibly responsible for hepatitis C found later on. Pathophysiology, clinical findings and therapy of the disease are discussed.

Adult↗

PubMed1993

[Alpha-interferon therapy in Crohn's disease: initial clinical results].

4 therapies in 3 patients (1 female, 2 male) suffering from steroid dependent Crohn's disease are described. Interferon alpha-2b was administered for 24 weeks (3 million I.U. per day for 4 weeks, and 3 x 3 million U.I. per week for 20 weeks). Prednisolone dosage at start of therapy depended on initial inflammatory activity (CDAI). The daily dose was reduced stepwise and omitted after 12 weeks. In two courses patients did not respond and therapy had to be halted after 12 and 14 weeks' duration because of increasing disease activity. During the other two treatments a decrease in disease activity of 118 and 70 CDAI units (in both cases after 8 weeks) could be achieved. In particular, the course in one patient with abundant intestinal and extraintestinal inflammatory activity was quite impressive: extraintestinal activity disappeared completely within 10 days, CDAI ameliorated substantially for 30 weeks and the patient could be treated without steroids for a total period of 18 weeks. As a preliminary conclusion from the cases described up to now, it can be speculated that females probably respond more favorably to a combined therapy with interferon alpha and corticosteroids. Moreover, we suggest that the potential of interferon in Crohn's disease might be to overcome a steroid refractory disease state rather than to allow omission of steroid medication which could not be further reduced without exacerbation. Clearly, present experience of interferon therapy in Crohn's disease is still too scarce and more work needs to be done to define the role of interferon in IBD.

Adult↗

PubMed1993

[Turcot syndrome--a rare extra-intestinal manifestation of familial adenomatous polyposis?].

The case of a 15-year-old male with Turcot syndrome is presented. When the patient was aged 10 years a medulloblastoma was diagnosed. Five years later he developed multiple adenomatous polyps of the colon and multiple "congenital hypertrophy of the retina" (CHRPE), the most common extraintestinal manifestation of FAP, were described. Family history revealed familial adenomatous polyposis with 12 family members exhibiting a FAP. The mode of inheritance of Turcot syndrome is controverted. Our case strengthens the hypothesis that the syndrome is a further extraintestinal (rare) manifestation of the FAP gene.

Adenomatous Polyposis Coli↗

PubMed1993

[Irritable colon and constipation].

Irritable bowel syndrome is a very common clinical problem with a broad spectrum of severity. The management includes a combination of positive diagnosis of typical symptoms with limited investigations to exclude underlying structural or biochemical disorders. Therapeutic trials focus on the relief of predominant symptoms. Identification and modification of factors exacerbating symptoms, behavioural techniques and pharmacologic agents directed to the presumed gastrointestinal motor dysfunction are required. Psychological support by the physician is the most important part of treatment. Chronic constipation may be the predominant symptom of irritable bowel syndrome. Underlying organic disorders must be excluded by clinical examination and endoscopy. Severe chronic constipation requires further investigation of colonic motility and defecation. High fibre diet, osmotic laxatives and procinetic agents may lead to an improvement. In rare cases surgery may be indicated.

Chronic Disease↗

PubMed1993

[Lymphoepithelial cyst of the pancreas].

In a routine check-up a cystic tumour of the head of the pancreas was found in a asymptomatic 59-year-old man. As the investigation with several radiological means was not conclusive and there was found an increased value for CEA in the cysts liquid a explorative laparotomy was performed. Already the intraoperatively performed histology confirmed the diagnosis of a benign lymphoepithelial cyst of the pancreas. After local resection the postoperative course was uneventful and the patient is today, one year later, disease-free. Lymphoepithelial tumours are well known in the parotis whereas in the pancreas only 5 cases have been reported. For positivity for CA 19-9 marker we found some evidence for the hypothesis that these kind of cysts could derive from metaplastic tissue in obstructed pancreatic ducts.

Biomarkers, Tumor↗

PubMed1992

[How does oligo- en asymptomatic non-tropical sprue present itself?].

According to the computerized ICD registration, 20 new cases of non-tropical sprue were detected in our outpatient clinic between 1979 and 1990. 8 of these patients had an oligo- or asymptomatic form of this disease (40%). The clinical presentation and spectrum of abnormal laboratory findings in these 8 cases are described in detail. It is concluded that laboratory parameters indicating malabsorption, especially hematologic changes, are helpful for the detection of the oligo- and asymptomatic form of non-tropical sprue, and that, in cases with undetermined anemia, this form of sprue must be considered in etiologic differential diagnosis. Finally, it seems advisable to perform a biopsy as a routine procedure during endoscopy in cases with unclear anemia.

Adult↗

PubMed1992

[Endosonography: progress in the diagnosis of endocrine pancreatic tumors].

Diagnostic procedures for secreting endocrine pancreatic tumors comprise biochemical tests, CT scans, conventional abdominal sonography, angiography and occasionally MR imaging and isotope scans. Due to their small size, insulinomas and gastrinomas, the most common of these tumors, elude these diagnostic procedures. Preoperative sonography and CT scans were negative in over 60%, angiograms in 35% of the patients. The example of a patient with insulinoma demonstrates that in the future endosonography will offer itself as an accurate method with little risk.

Aged↗

PubMed1992

[Diagnostic problems in infectious colitis in the framework of an HIV infection].

Between 1988/89 1207 HIV-positive patients were registered at the Medical Policlinic of the University Hospital Zurich. In 57 of these patients colonoscopy or rectosigmoidoscopy was performed because of serious symptoms or symptoms refractory to therapy (diarrhea, bloody diarrhea, massive abdominal pain, weight loss). 24/57 (42%) had a negative colonoscopy and in 6/57 patients (10%) Kaposi's sarcoma was found. 14/57 (25%) had unspecific colitis. In 13/57 (23%) cases with colitis, one or multiple bacterial or viral agents were diagnosed: CMV (n = 5), herpes (n = 2), Mycobacterium avium-intracellulare (n = 3), different bacterial agents (n = 5), HIV (n = 1). One patient had a double and one a triple infection. Another had colitis with HIV as the only isolated pathogenic agent in the colon epithelium.

Adult↗

PubMed1991

[Long-term therapy of Ménétrier disease using ranitidine and pirenzepine].

A 22-year-old woman with hypertrophic protein-losing gastropathy (Ménétrier's disease) is described. During treatment with ranitidine (Zantic) and pirenzepine (Gastrozepin) the gastric mucosa and protein loss were normalized within 4 years. Clinical and histological remission has now been observed for 5 and 3 years respectively. In a 57-year-old woman with hypertrophic gastropathy, 8 months' treatment with ranitidine and pirenzepine was associated with decrease in protein loss and improvement of the histological appearance of the gastric mucosa after one year. Long-term treatment of hypertrophic gastropathy with ranitidine and/or pirenzepine should, therefore, be considered in such cases instead of gastrectomy.

Adult↗

PubMed1991

[Image-guided thin needle puncture of tumors of the gastrointestinal system. Puncture technique and handling of materials].

The image-guided fine-needle aspiration biopsy in the diagnosis of gastro-intestinal tumors has reached a very high value out of other diagnostic tools. The results of this method depend directly on the technical performance (aspirator, technicians, cytologist) of the punction and processing of the obtained cytological material. The following paper is a brief communication on technical methods and experience in performing the image-guided fine-needle aspiration biopsy at the university hospital of Zurich.

Adenoma↗

PubMed1990

[Fever, somnolence, vomiting, diarrhea].

A 69-year-old female was admitted because of a febrile state, somnolence, nausea and diarrhea. Addison's disease known to have developed several years earlier after adrenal tuberculosis suggested Addisonian crisis triggered by an acute infection. Therapy with steroids and substitution of electrolytes and fluid led to rapid improvement. Streptococcus bovis was identified as causative agent. The known association of this germ with cancer of the colon led to further investigation which revealed cancer of the sigmoid and incidental cancer of a salpinx. After surgical removal of both cancers, the patient has remained free of complaints under substitution of steroids.

Adenocarcinoma↗

PubMed1990

[Strategy in sonographic suspicion of a parasitic disease of the liver (echinococcosis and amebic abscess)].

Ultrasonography is a widely used, early available and well established method in the examination of abdominal symptoms. The strategy for investigation of focal liver lesions, suspected to be parasitoses of the liver (echinococcus cysts or amebic abscess) is shown. The ultrasonographic morphology of echinococcosis and amebic abscess is characteristic, although it is imperative to distinguish these lesions from other tumorous or cystic lesions. The diagnosis suspected through case history and clinical appearance is confirmed by modern serological tests in 90 to 95% of echinococcosis and in 95 to 100% of amebiasis. Fine-needle aspiration guided by ultrasound is indicated in cases of a negative serological result in order to exclude a pyogenic abscess. This evaluation allows a fast diagnosis and efficient therapy.

Biopsy, Needle↗